HEDIS Toolkit Booklet

HEDIS 101 For Providers

The Healthcare Effectiveness Data and Information Set (HEDIS®) is the health care industry’s most widely used set of performance measures. Our NCQA accreditation and provider incentive programs depend, in part, upon this annual evaluation. The New York State Department of Health also requires us to fulfill Quality Assurance Reporting Requirements (QARR). Learn how these data collection efforts may affect your practice.

For an in-depth look at the data collection process and tips on achieving higher HEDIS scores, please read the HEDIS Summary Tool for CDPHP Providers.

Behavioral Health Guidelines are Online

CDPHP utilizes both industry-standard and internally developed clinically based medical necessity criteria. The industry-standard behavioral health criteria are Milliman Care Guidelines and ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders. Internally developed criteria are determined based on current industry standards.