About HEDIS

HEDIS is a quality and performance assessment tool that employs standardized measures set by the National Committee for Quality Assurance (NCQA). The Centers for Medicare & Medicaid Services (CMS) requires the use of HEDIS standardized measures to assess quality and performance across managed care organizations.

The review is conducted each January to May 15 by all NCQA-accredited managed care organizations. HEDIS takes a retroactive look at care and services through claims, medical record reviews, and member surveys. The results guide the organization in developing quality initiatives, assessing performance, and building educational programs.