About HEDIS

The Healthcare Effectiveness Data and Information Set (HEDIS^®)¹ is one of the most widely used set of health care performance measures in the United States. It is developed and maintained by the National Committee for Quality Assurance (NCQA). These measures are designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans. The performance measures in HEDIS are related to many significant public health issues such as cancer, heart disease, smoking, asthma, and diabetes. HEDIS also includes a standardized survey of consumers' experiences that evaluates plan performance in areas such as customer service, access to care, and claims processing.

Many of these measures are scored using claims data; however, additional information that may only be found in a member's chart is often needed, and this is where chart retrieval and abstraction comes into play. In 2023, PrimeWest Health’s internal HEDIS Team began performing chart retrieval and abstraction of hybrid HEDIS measures rather than utilizing a third-party vendor. Because of the direct electronic health record (EHR) access we have to some of our contracted providers, we are able to retrieve records without sending a request and waiting for a response. In addition, an increasing number of providers are utilizing the PrimeWest Health file transfer protocol (FTP) site to upload records, which also makes the process of transferring records easier for both providers and PrimeWest Health staff.

In 2016, NCQA launched a reporting standard for HEDIS known as Electronic Clinical Data Systems (ECDS) reporting. This method presents PrimeWest Health with the opportunity to shift our focus from hybrid record collection, which includes data based on claims analysis and in-office record reviews, to electronic reporting. We encourage providers to consider sharing data with us electronically to reduce the burden of data collection for you and to continue helping us improve quality reporting and activities.

Please remember that if you are a PrimeWest Health provider, you are contractually obligated to comply with these requests. Refer to the Requirements for Providers section of the Provider Manual for more information.

If you are a county case manager, PrimeWest Health may ask for your help in improving our HEDIS scores. County case managers have unique relationships with our members and are well situated to encourage them to receive appropriate health services or screenings.

¹HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)

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Updated_07/11/2025