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 services 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).

Please log into our Provider Portal for HEDIS material, including annual trends, tip sheets, and a coding guide: https://provider.molinahealthcare.com/.

If you do not yet have a login for the Portal, please begin registration here: https://provider.molinahealthcare.com/Provider/UserResponsibility.

The Provider Network Management team will assist you with questions or concerns about the Provider Portal.

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

 

 

 

All summaries of the measures contained herein are reproduced with permission from HEDIS Volume 2: Technical Specifications for Health Plans by the National Committee for Quality Assurance (NCQA).

The information presented herein is for informational and illustrative purposes only. It is not intended, nor is it to be used, to define a standard of care or otherwise substitute for informed medical evaluation, diagnosis and treatment which can be performed by a qualified medical professional. Molina Healthcare, Inc. does not warrant or represent that the information contained herein is accurate or free from defects.

COPYRIGHT NOTICE AND DISCLAIMER
The HEDIS® measures and specifications were developed by and are owned by NCQA. The HEDIS measures and specifications are not clinical guidelines and do not establish a standard of medical care. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures and specifications. NCQA holds a copyright in these materials and can rescind or alter these materials at any time. These materials may not be modified by anyone other than NCQA. Use of the Rules for Allowable Adjustments of HEDIS to make permitted adjustments of the materials does not constitute a modification. Any commercial use and/or internal or external reproduction, distribution and publication must be approved by NCQA and are subject to a license at the discretion of NCQA. Any use of the materials to identify records or calculate measure results, for example, requires a custom license and may necessitate certification pursuant to NCQA’s Measure Certification Program. Reprinted with permission by NCQA. © 2020 NCQA, all rights reserved.

Limited proprietary coding is contained in the measure specifications for convenience. NCQA disclaims all liability for use or accuracy of any third-party code values contained in the specifications.
The American Medical Association holds a copyright to the CPT® codes contained in the measure specifications.

The American Hospital Association holds a copyright to the Uniform Billing Codes (“UB”) contained in the measure specifications. The UB Codes in the HEDIS specifications are included with the permission of the AHA. The UB Codes contained in the HEDIS specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting HEDIS measure results or using HEDIS measure results for their internal quality improvement purposes. All other uses of the UB Codes require a license from the AHA. Anyone desiring to use the UB Codes in a commercial product to generate HEDIS results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact ub04@aha.org.


The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.