HEDIS Coding
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HEDIS Coding

Developed by the National Committee on Quality Assurance (NCQA), the Healthcare Effectiveness Data Information Set (HEDIS) is a tool to assess the performance of health plans based on the quality of care and services provided to their members.

Maximize reimbursements and streamline compliance with our HEDIS coding service.

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HEDIS is used by more than 90 percent of America’s managed care health plans.

To meet HEDIS benchmarks and coding guidelines, insurers and health care providers need to have the right team and processes in place. An experienced medical billing and coding company based in the U.S., Outsource Strategies International (OSI) provides reliable HEDIS medical record review support. Our comprehensive data collection and review process include data retrieval and abstraction, assessment of medical records, and smooth delivery of results.

Our HIPAA-compliant HEDIS audit and coding services help insurers meet NCQA’s quality goals and healthcare practices maximize HEDIS reimbursement. We are well-equipped to meet your complex coding and data abstraction requirements. Our certified coders are experts in ICD-10 coding.

Comprehensive HEDIS Coding Support

Our skilled medical coding team assigns the correct NCQA-approved CPT and ICD-10 codes to indicate that well-care was provided so that HEDIS quality of care goals can be indicated through claims data.

HEDIS consists of 75 measures across 8 domains of care. NCQA uses these measures for commercial, Medicare and Medicaid plans. These measures use one of the three methods of data collection – Administrative, Hybrid and Survey.

With their advanced knowledge of CPT and ICD codes and HEDIS measures for reporting, our team can accurately and quickly evaluate the codes and compile medical charts quickly. All procedures that come under the following areas will be accurately coded.

  • Asthma medication use
  • Persistence of beta-blocker treatment after a heart attack
  • Controlling high blood pressure
  • Comprehensive diabetes care
  • Breast cancer screening
  • Cervical cancer screening
  • Antidepressant medication management
  • Childhood and adolescent immunizations
  • Adolescent well-child visit
  • Childhood and adult weight/BMI assessment

Comprehensive HEDIS Medical Record Review Services

OSI also offers HEDIS medical record review services for insurers. We will review the services specific to each HEDIS measure including history, lab results, problem list, specialist consultations, and chart notes for a specified period.

  • Mailing of medical chart requests to provider
  • Chart retrieval process to suit provider
  • Medical chart review with data retrieval and reporting
  • Facility to view and access scanned and uploaded medical records
  • Compiling of all documentation necessary for the NCQA audit

In addition to coding and review, we perform mock HEDIS audits to help clients reporting HEDIS measures evaluate their compliance. We help you monitor, follow and enhance HEDIS compliance, build and measure proprietary quality metrics, allow year-round compliance reporting and simplify the process of NCQA submission to boost health plan ranking.

Professional Support from an Experienced HEDIS Coding Company

We ensure:

  • Smooth workflow processes
  • Reliable data and reports
  • Improved rates and higher health plan ranking with HEDIS compliance
  • HIPAA-compliant services
  • Competitive pricing
  • End-to-end customer support

The skilled team at OSI can handle your temporary HEDIS work for medical charts quickly, efficiently and affordably to meet the submission deadline – Call us today!