HEDIS

Molina Healthcare uses the Healthcare Effectiveness Data and Information Set (HEDIS®) tool every year for quality reporting. This is done by looking at the type of care and se​rvices provided. Along with more than 90% of American health plans, Molina Healthcare uses HEDIS® results to track quality performance from year to year and to identify opportunities for improvement. Molina's goal is to be better than 75% of other Medicaid health plans in the nation. During the first two quarters of each year, provider offices may be contacted to submit specific medical records for review, an integral part of the HEDIS® data collection process. HEDIS® data collection is in compliance with the Health Insurance Portability and Accountability Act (HIPAA).

Detailed results can be found by clicking the​ link below:
HEDIS® Annual Trends

Molina Healthcare of Illinois has created a HEDIS® coding guide to help providers improve their HEDIS® performance. The guide can help providers understand HEDIS® coding and increase their knowledge about HEDIS® measure requirements.

HEDIS® Coding Guide – please click here to view.

2020 Measures of Focus Guide

Adult's Access to Preventive/Ambulatory Health Services (AAP)

Adults BMI Assessment (ABA)

Adolescent Well-Care Visit (AWC)

Breast Cancer Screening (BCS)

Children and Adolescents' Access to Primary Care Practitioners (CAP)

Cervical Cancer Screening (CCS)

Chlamydia Screening in Women (CHL)

Childhood Immunization Status (CIS)

Care for Older Adults (COA)

Colorectal Cancer Screening (COL)

Appropriate Testing for Pharyngitis (CWP)

Immunizations for Adolescents (IMA)

Use of Imaging Studies for Low Back Pain (LBP)

Lead Screening in Children (LSC)

Postpartum Care (PPC)

Timeliness of Prenatal Care (PPC)

Appropriate Treatment for Upper Respiratory Infection (URI)

Well-Child Visits First 15 Months of Life (W15)

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34)

Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC)

Follow-Up Care for Children Prescribed ADHD Medication (ADD)

Antidepressant Medication Management (AMM)

Asthma Medication Ratio (AMR)

Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)

Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (AAP)

Medication Management for People with Asthma (MMA)

Pharmacotherapy Management of COPD Exacerbation (PCE)

Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA)

Statin Therapy for Patients with Cardiovascular Disease (SPC)

Statin Therapy for Patients with Diabetes (SPD)

Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who are Using Antipsychotic Medications (SSD)

Transitions of Care (TRC)

Controlling High Blood Pressure (CBP)

Follow-Up After Hospitalization for Mental Illness (FUH)

Comprehensive Diabetes Care (CDC)

Initiation & Engagement of Alcohol & Other Drug Abuse or Dependence Treatment (IET)

If you have any questions, would like additional information about HEDIS®, or have suggestions for our Quality Improvement Program, please contact Provider Services.

* Printed copies of information posted on our website are available upon request.

HEDIS® is a Registered Trademark of the National Committee for Quality Assurance.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​