University HealthCare Alliance

November 12, 2019

Optum Insider | HEDIS Requirements for Breast Cancer Screening

The National Committee for Quality Assurance’s (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) includes standard measures that are used to evaluate a health plan’s performance. Through data collection and reporting, health plans also use HEDIS measures as an opportunity to identify areas for improvement in care.

The Centers for Medicare & Medicaid Services (CMS) also requires HEDIS data reporting to help monitor the quality of Medicare Advantage plans and to provide information to help members compare those plans based on CMS’ Star Ratings. This tool, which details HEDIS requirements for breast cancer screenings, a component of CMS’ Star Ratings, is focused on the impact of that HEDIS measure for Medicare Advantage patients.

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