Quality/HEDIS

DMA HEDIS (Healthcare Effectiveness Data and Information Set) Reporting

• Medicaid HEDIS Results for 2012, 2013 and 2014 Reporting
• Medicaid HEDIS Results for 2009, 2010 and 2011 Reporting

CareAnalyzer HEDIS Reporting

Effective with HEDIS 2012 reporting NC Medicaid is utilizing CareAnalyzer, NCQA certified software, for production of its HEDIS reporting.  CareAnalyzer is a browser-based analytic tool that combines elements of patient risk, care opportunities and provider performance to meet HEDIS reporting requirements.

Claim History Availability

On July 1, 2013 the NC DHHS Division of Medical Assistance transitioned to NC Tracks, a new Medicaid Management Information System, for claims processing.  At that time Medicaid administrative claims data was loaded with five years of claim data.  Production data will eventually include ten years of claim data on a rolling basis.

Dual-Eligibles

Recipients dually enrolled in both NC Medicaid and Medicare are excluded from the Medicaid HEDIS reporting because DMA claims may be incomplete for dual-eligible enrollees.  As a result some reported NC HEDIS rates may not be comparable to those of other states, particularly for measures which include enrollees over age 65

Race and Ethnicity

Race and ethnicity codes are determined when recipients enroll into the NC Medicaid program.  For individuals with insufficient information to define a race or ethnicity code the “Unreported” code is applied.

NCHC CHIP Population

The NC Health Choice (NCHC) Children’s Health Insurance Program (CHIP) member population is not included in the NC Medicaid HEDIS reporting, and any required HEDIS measures are reported separately for CHIP members.