FLASH: eviCore Closed in Observance of Martin Luther King, Jr. Day and HEDIS Chart Reviews Coming Soon
January 16, 2020eviCore Closed in Observance of Martin Luther King, Jr. Day
Our preauthorization vendor, eviCore, will be closed Monday, January 20, 2020, in observation of Martin Luther King, Jr. Day. Similarly to other holidays, cases can be initiated on the web, but eviCore call centers will be closed.
If you have questions, contact your provider relations specialist.
HEDIS® Chart Reviews Coming Soon
Each spring, Health Alliance collects data to determine how we measure up against national averages for HEDIS® (the Healthcare Effectiveness Data and Information Set). This data collection and analysis indicates where we need to focus our quality efforts and is required for NCQA accreditation.
Successfully generating our HEDIS report depends largely on the cooperation we receive from provider office staff. Members of our HEDIS Team may request remote access to your electronic medical record system. When that is not possible, we will request a time to visit your office in the spring to review specific medical records or ask you to copy and fax, or mail records to us as part of the audit. All individually identifiable information concerning patients will be kept strictly confidential in compliance with HIPAA regulations.
If you have any questions about HEDIS, contact the Quality Management Department at
800-851-3379, extension 8016.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Updates to HEDIS Measures for 2019
The following HEDIS measures have been updated for 2019:
- Prenatal and Postpartum (PPC):
- Timeliness of Prenatal Care – In an effort to standardize and simplify prenatal care visit requirements NCQA has revised this measure to include any prenatal care visit that shows a diagnosis of pregnancy meets criteria. In addition to this there are other methods used to satisfy this component of the measure.
- Postpartum Care – NCQA has expanded the timing of postpartum care visits to be on or between 7 and 84 days after delivery. In addition, more criteria was added to satisfy postpartum visits including the following:
- Cesarean incision/wound or perineal check
- Screening for one of the following: depression, anxiety, tobacco use, substance use disorder or preexisting mental disorders
- Gestational diabetes glucose screening
- Infant care or breast feeding counseling
- Family planning or resuming intercourse
- Sleep and fatigue counseling
- Discussion of resuming physical activity/health weight
- Exclusion of members who have deceased – If a member has deceased anytime during 2019 they may be excluded from the HEDIS measures.
If you have questions, contact your provider relations specialist.