HEDIS provider guides 

HEDIS training for providers and medical offices

Healthcare Effectiveness Data and Information Set (HEDIS®) metrics help evaluate the quality of patient care and service by health plans and medical providers. Learn how to turn routine workflows into meaningful improvements in patient care – and higher quality ratings.

Your Key Role in HEDIS (eLearning course)

This eLearning course for providers and medical office staff explains HEDIS basics and how to excel on key measures:

• Controlling High Blood Pressure (CBP)
• Glycemic Status Assessment for Patients with Diabetes (GSD)
• Eye Exam for Patients with Diabetes (EED)
• Kidney Health Evaluation for Patients with Diabetes (KED)
• Colorectal Cancer Screening (COL-E)

The course equips care teams to:

• Identify eligible patients and exclusions
• Support care coordination for managing chronic conditions
• Document and code care so services count toward HEDIS

HEDIS provider guides

In our efforts to support our providers, Blue Shield of California has developed the HEDIS provider guides to assist providers and their office and billing staff in successfully maximizing their quality performance scores. 

These guides provide concise information on the National Committee for Quality Assurance (NCQA) HEDIS measures along with resources that will help improve health outcomes.

Please note that the HEDIS provider guides are based on the most recent HEDIS technical specifications and are subject to change based on guidance from NCQA and the Centers for Medicare & Medicaid Services (CMS).  Please refer to the appropriate agency for additional guidance.

 Breast cancer screening mammogram (PDF, 752 KB)

 Colorectal cancer screening (PDF, 564 KB)

 Controlling High Blood Pressure (CBP) (PDF, 280 KB)

 Eye exam for patients with diabetes (PDF, 626 KB)

 Glycemic Status Assessment for Patients with Diabetes (GSD) (PDF, 395 KB)

 Kidney health evaluation for patients with diabetes (PDF, 526 KB)