HEDIS Checklist

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Are you ready for next year’s HEDIS season?
Use the checklist below to keep your HEDIS team on track
for a successful HEDIS submission.
HEDIS 2015 Checklist
To learn about Verisk Health’s HEDIS Solution, download our HEDIS Management Overview.
1 Determine what solution you will use for this year’s submission.
2 Identify your internal HEDIS team and set up a kickoff meeting.
3 Ensure your HEDIS project plan aligns with auditor expectations.
4 Set up a training plan.
5 Document details required to build your HEDIS project plan.
6 Create a detailed project plan and align input file specifications.
7 Perform a test run.
8 Review data post test run.
9 Perform a production run using the updated data that has been corrected.
10 Prepare CAHPS submission.
11 Retrieve your records and begin abstraction.
12 Perform an admin data refresh.
13 Submit your MRRV data.
14 Continually review status of project tasks.
15 Complete any state submissions.
16 Plan provider and member outreach to occur from June to September.
A proactive approach to HEDIS reporting will give you more time to ensure data and rate
accuracy before the final submission.

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Determine what solution you will use for this year’s submission.
As early as possible, you will need to decide whether you will use a vendor for
reporting as well as retrieval, abstraction, and CAHPS.
1
2
Ensure your HEDIS project plan aligns with auditor expectations.
Work with your auditor to understand requirements and validate the
timeline during the season.
3
Set up a training plan.
In order to ensure your team learns how to effectively use the software, schedule
training for analyst staff, medical record review management, and any staff who
will be doing abstraction or over-reads.
4
Identify your internal HEDIS team and set up a kickoff meeting.
If you are using a HEDIS vendor, use the kickoff meeting to introduce your vendor’s HEDIS team
to your internal team. This is the point at which you should discuss reporting requirements.
HEDIS 2015 Checklist Details

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Document details required to build your HEDIS project plan.
Be sure to gather reporting requirements, submission dates, vendor
contributions, and needed staff contributions.
5
Review data post test run.
Based on variances and issues detected in the test run,
review data mapping and source data to determine if
any changes are needed.
8
7
Perform a test run.
During this run, look for any large variances from the previous year. Possible variances
could be caused by membership increases or product additions. Checking for errors in the
data during this stage can help you figure out the software and test input specifications.
Create a detailed project plan and align input file specifications.
If you’re going to use a vendor, you will need to map to their specifications. This project
plan should detail when you will have the file mapping completed. The project plan is
integral in planning for your test run.
6

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Perform a production run using the updated data that has been corrected.
By this point in the timeline, your vendor should be fully certified. A production run should
include your production sample pull and chase logic; you want to ensure that your chase
logic returns expected results. Aside from an admin refresh, this data should be ready
to submit your admin rates.
9
Prepare CAHPS submission.
Generate extract for member addresses to
send CAHPS surveys.
10
Retrieve your records and begin abstraction.
Either your internal staff or a vendor should employ an over-read process
to ensure the abstraction data is correct.
11
Perform an admin data refresh.
This will ensure you receive the data from March or April that would not have been
included in your production run.
12

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15
MAY
Submit your MRRV data.
All chart review is to be completed by May 15th
and sent to your auditor.
13
15
Complete any state submissions,
if applicable.
Continually review status of project tasks.
Be sure to remove any roadblocks that may prevent
IDSS and/or PLD submission by June 15th.
14
15
JUNE
Plan provider and member outreach to occur from June to September.
Use software or a vendor to configure outreach criteria and generate communication to
members. Align outreach with goals to close gaps in care.
16

HEDIS Checklist

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