Change is in the air. Advantmed has been monitoring

updates from the National Committee for Quality

Assurance (NCQA) and the industry overall, and

we’ve noted some important changes projected for the

coming months and years.

Do you know what to expect? More importantly, are you

prepared? Is your vendor ready?

We’ve summarized the changes below. And we’ve

provided a few key questions you need to answer to

confirm that you’re all set for this HEDIS® season.

Allowable Adjustments

Within Volume 2 of the HEDIS® 2020 Technical Specifications,

NCQA includes measure-specific allowable adjustment rules after

each measures’ Data Elements for Reporting section. The adjusted

measures cannot be used for HEDIS® submission but will be

accepted for other reporting purposes. The objective of the allowable

adjustments is to keep the clinical intent of the measure.

The Questions You Need to Answer

• Is your vendor certifying for allowable adjustments this year?

• Can health plans configure the measures themselves? Or does your

vendor need to configure and run the measures on your behalf?

• How quickly can you create, run, and view an adjusted measure?

IDSS 2020-2021 Redesign

For HEDIS® 2021 (MY 2020 data), health plans will submit final rates to

NCQA’s IDSS site in a revised format. This redesign includes updates

to all measure data elements to better align with each measure’s

submission requirements and Volume 2 of the HEDIS® Technical

Specifications. In addition, health plans will not be allowed to manually

edit or enter measures within the IDSS site.

The Questions You Need to Answer

• Do you have a plan to test the changes?

• Is your HEDIS® vendor participating in NCQA’s Data Collection

Advisory Panel (DCAP) IDSS testing project?

• Can all measures be exported into the XML IDSS layout, including

measures such as BCR, so that no manual intervention is needed?

WHAT YOU NEED TO

KNOW NOW

HEDIS® 2020:

Anticipated Upcoming Changes and the

Questions You Need to Answer to Ensure

You’re Ready

www.advantmed.com877.896.7350

Timeline Specification Changes

On July 1, 2020, NCQA will release HEDIS®

specifications for MY 2020 and MY 2021. Historically,

specifications have been released seven months into

the measurement year, causing HEDIS® reporting

to be very retrospective in nature. With MY 2021’s

specifications released well in advance of the season,

reporting will likely shift to a more prospective focus.

The Questions You Need to Answer

• When will your vendor release measures for HEDIS®

MY 2020 and MY 2021?

• Will your vendor be able to support both HEDIS®

versions at a given time?

• How will this impact your prospective reporting and

outreach efforts?

Digital Measures

A total of 19 digital measures (machine-readable

specifications) are available from NCQA for reporting.

This includes 11 Electronic Clinical Data System (ECDS)

measures, of which one will be publicly reported for

HEDIS® 2020 (Prenatal Immunization Status [PRS]).

The Questions You Need to Answer

• Is your vendor supporting the development of

NCQA’s 19 digital measures?

• Can rates be viewed for both the traditional measure

and e-measure for BCS-E, COL-E, and ADD-E? Are

the results similar?

• Do you have the support you need to address any

data stumbling blocks?

www.advantmed.com877.896.7350

WHAT YOU NEED TO KNOW NOWHEDIS® 2020:

Getting answers to these questions

will pave the way for a smoother

HEDIS® season. For more information

about Advantmed and our quality

improvement solutions, please

visit www.advantmed.com or

call 877.896.7350.