September 2, 2020
We’ve updated two behavioral health tip sheets to help you satisfy Healthcare Effectiveness Data and Information Set (HEDIS) 2020-2021 measures and code appropriately. These measures from the National Committee for Quality Assurance (NCQA) help ensure our members receive appropriate care.
The tip sheets include measurement requirements, medical record best practices and billing codes. Compliance with HEDIS measures reduces the need for you to send medical records later for review.
- Members ages 13 and older
- New1 diagnosis of alcohol or other drug (AOD) abuse or dependence
- Treatment may occur in the inpatient, residential, outpatient,2 medication-assisted treatment (MAT) or telehealth setting
- Members ages 6 and older
- Discharged from an acute inpatient hospital stay
- Principal diagnosis at discharge is mental illness or intentional self-harm
- Outpatient follow-up visits must be with a mental health provider3 (includes telehealth visits) or in certain outpatient4 settings
* Measurement year 2020 and measurement year 2021
1 Defined as no diagnosis of AOD abuse or dependence in previous 60 days
2 Outpatient treatment includes an intensive outpatient or partial hospital program
3 Psychologist, Psychiatrist, Clinical Social Worker, Mental Health Occupational Therapist, Psychiatric/Mental Health Nurse Practitioner/Clinical Nurse Specialist, Neuropsychologist, Psychoanalyst, Professional Counselor, Marriage and Family Therapist
4 Community mental health center, electroconvulsive therapy, transitional care management services and includes intensive outpatient or partial hospital programs
HEDIS is a registered trademark of the NCQA
The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.