HEDIS Compliance

Transition of Care (TRC)

Tracks patient transitions from inpatient to outpatient care, including Notification of Admission (NIA), Receipt of Discharge Information (RDI), Patient Engagement after Discharge (PED), and Medication Reconciliation Post Discharge (MRP).

Controlling High Blood Pressure (CBP)

Evaluates the percentage of adults (18–85) diagnosed with hypertension whose blood pressure is under control.

Diabetes Care

Includes multiple sub-measures for managing and monitoring diabetes, such as HbA1c control, Eye Exams (EED), Kidney Evaluation (eGFR/uACR), Blood Pressure Control (BDP), and care for people with serious mental illness.

Care for Older Adults (COA)

Focuses on adults 66+ to ensure medication review, functional status assessment, pain assessment, and advance care planning.

Medication Adherence

Measures patient adherence to prescribed medications for statins, diabetes, and hypertension (RAS Antagonists).

Cancer Screenings

Encourages early detection of cancer through regular screening for colorectal, breast, and cervical cancers.

Breast Cancer Screening (BCS)

Assesses the rate of mammograms for women aged 50–74 to screen for breast cancer.

Cervical Cancer Screening (CCS)

Monitors the completion of cervical cancer screenings for women aged 21–64.

Colorectal Cancer Screening (COL-E)

Tracks colorectal cancer screening for adults aged 50–75 through colonoscopy, FIT, or FOBT tests.

Child Immunization Status (CIS)

Measures if children under age 2 received recommended immunizations.

Immunization for Adolescents (IMA)

Monitors adolescent vaccinations including meningococcal, Tdap, and HPV by age 13.

Lead Screening in Children (LSC)

Tracks whether children received at least one lead blood test by their second birthday.

Prenatal and Postpartum Care (PPC)

Evaluates if pregnant women received timely prenatal care and follow-up postpartum visits.

Weight Assessment and Counseling for Children and Adolescents (WCC)

Assesses documentation of BMI and counseling for nutrition and physical activity.

Developmental Screening in the First Three Years of Life (DEV-CH)

Ensures children are screened for developmental delays at appropriate ages.

Plan All-Cause Readmissions (PCR)

Measures unplanned hospital readmissions within 30 days after discharge.

Depression Screening & Follow-Up (DSF)

Evaluates if patients are screened for depression and receive follow-up if needed.

Osteoporosis Management in Women (OMW)

Ensures women aged 67+ who had a fracture receive bone density testing or treatment.

Medication Adherence – Part D

Measures adherence for diabetes medications, RAS antagonists, and statins under Medicare Part D.

Opioid Safety Monitoring

Identifies high-risk opioid prescriptions and usage patterns to improve safety.

Drug Therapy for Rheumatoid Arthritis (DRA)

Ensures patients with rheumatoid arthritis are prescribed appropriate DMARD therapy.

Medication Therapy Management (MTM)

Tracks provider engagement in performing medication reviews and adjustments.