Quality Programs: HEDIS & PQA
Provider Forms
| File Name | Format | Updated |
|---|---|---|
| HEDIS Best Practices Guide for Providers (Measurement Year 2023) | Apr 2023 | |
| Comprehensive HEDIS Documentation & Coding Guide (Measurement Year 2022) | Mar 2022 |
HEDIS Measures Tip Sheet
Healthcare Effectiveness Data and Information Set (HEDIS)
|
HEDIS®1 Quality Measures Tip Sheets |
Date Published |
Applies to: |
||||
|---|---|---|---|---|---|---|
|
Florida Blue Commercial |
FEP2 |
Florida Blue Medicare Stars |
Florida Blue Medicare |
Truli for Health3 |
||
| Antidepressant Medication Mgmt (AMM) | Feb 2024 | ✓ | ✓ |
|
✓ |
|
| Adults' Access to Primary Care (AAP) |
Feb 2025 |
✓ |
|
|
✓ |
|
|
Mar 2023 |
✓ |
✓ |
|
✓ |
|
|
| Feb 2025 |
✓ |
✓ |
|
|
✓ |
|
|
Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB) |
Feb 2025 |
✓ |
✓ |
|
✓ |
|
| Feb 2025 |
✓ |
✓ |
|
|
|
|
| Feb 2025 |
✓ |
✓ |
✓ |
✓ |
✓ |
|
| Feb 2025 |
✓ |
✓ |
✓ |
✓ |
✓ |
|
| Breast Cancer Screening (BCS) | Feb 2025 |
✓ |
✓ |
✓ |
✓ |
✓ |
|
Cardiovascular Disease: Statin Use in Patients with Cardiovascular Disease (SPC) |
Feb 2025 |
✓ |
✓ |
✓ |
✓ |
✓ |
| Feb 2025 |
|
|
✓ |
✓ |
|
|
| Cervical Cancer Screening (CCS) | Feb 2025 |
✓ |
✓ |
|
|
✓ |
| Child and Adolescent Well-Care Visits (WCV) | Feb 2025 | ✓ |
|
|
|
✓ |
| Chlamydia Screening for Women (CHL) | Feb 2025 | ✓ |
|
|
|
|
| Feb 2025 |
✓ |
✓ |
✓ |
✓ |
✓ |
|
| Feb 2025 |
✓ |
|
|
✓ |
|
|
| Feb 2025 |
✓ |
✓ |
✓ |
✓ |
✓ |
|
| Feb 2025 |
|
|
✓ |
✓ |
|
|
| Glycemic Status Assessment for Patients with Diabetes (GSD) | Feb 2025 |
✓ |
✓ |
✓ |
✓ |
✓ |
|
Hemoglobin A1c Control for Patients with Diabetes (HBD) Please refer to the GSD tip sheet above. |
Retired 2023 | |||||
| Feb 2025 |
✓ |
✓ |
|
|
|
|
| Feb 2025 |
✓ |
✓ |
|
|
✓* |
|
| Feb 2025 |
✓ |
|
✓ |
✓ |
|
|
|
Medication Reconciliation Post-Discharge (MRP) |
See TRC |
|||||
|
Mental Illness: Follow-Up After Emergency Department Visit for Mental Illness (FUM) |
Feb 2025 |
✓ |
✓ |
|
✓ |
✓ |
| Feb 2025 |
✓ |
|
|
✓ |
✓ |
|
| Follow-Up After High-Intensity Care for Substance Use Disorder (FUI) | Feb 2025 |
✓ |
✓ |
|
✓ |
|
|
Initiation and Engagement of Substance Use Disorder Treatment (IET) |
Feb 2025 | ✓ | ✓ |
|
|
|
| Feb 2025 | ✓ | ✓ | ✓ |
|
|
|
| Feb 2025 |
✓ |
✓ |
|
✓ |
|
|
| Feb 2025 |
|
|
✓ |
✓ |
|
|
| Persistent Use of Beta Blockers After Heart Attack (PBH) |
Feb 2025 |
✓ |
|
✓ |
✓ |
|
| Appropriate Testing for Pharyngitis (CWP) | Feb 2025 | ✓ |
|
|
✓ |
|
| Feb 2025 |
✓ |
✓ |
✓ |
✓ |
✓ |
|
| Feb 2025 |
✓ |
✓ |
|
|
✓ |
|
| Feb 2025 |
|
|
✓ |
✓ |
|
|
| Upper Respiratory Infection: Appropriate Treatment for Upper Respiratory Infection (URI) | Feb 2025 | ✓ | ✓ |
|
✓ |
|
| Feb 2025 |
✓ |
|
|
|
✓ |
|
| Feb 2025 |
✓ |
✓ |
|
|
✓ |
|
PQA Measures Tip Sheet
Pharmacy Quality Alliance (PQA)
|
Pharmacy Quality Alliance (PQA) Quality Measures Tip Sheets |
Date Published |
Applies to: |
|||
|---|---|---|---|---|---|
|
Florida Blue |
FEP |
Florida Blue |
Florida Blue |
||
| Adherence to Antipsychotic Medications for Schizophrenia (SAA) | Feb 2024 | ✓ |
|
|
|
| Concurrent Use of Opioids and Benzodiazepines (COB) | Mar 2025 | ✓ | ✓ | ||
| International Normalized Ratio Monitoring of Those on Warfarin (INR) | Feb 2024 | ✓ |
|
|
|
| Mar 2024 |
✓ |
|
✓ |
|
|
| Mar 2024 |
✓ |
|
✓ |
|
|
| Mar 2024 |
✓ |
|
✓ |
|
|
| Monitoring of Individuals on Long-Term Opioid Therapy (AMO) | Feb 2024 | ✓ |
|
|
|
| Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (POLY-ACH) | Mar 2025 | ✓ | |||
| Mar 2024 |
✓ |
|
✓ |
|
|
1 HEDIS (Healthcare Effective Data and Information Set) is a registered trademark of the National Committee for Quality Assurance (NCQA).
2 Federal Employee Program®
3 Health coverage is offered by Truli for Health, an affiliate of Florida Blue. These companies are Independent Licensees of the Blue Cross and Blue Shield Association.
* Truli for Health will not include influenza in CIS measurement.