Provider Alerts

The State of California Department of Health Care Services (DHCS) requires HPSJ to conduct an annual review and audit called HEDIS or Healthcare Effectiveness Data and Information Set. There are two major measures in the Women’s Health HEDIS Measure domain. This alert provides the most current and up to date DHCS and HEDIS/National Committee for Quality Assurance (NCQA) for annual review and audit including documentation requirements and/or exclusions.

1. Cervical Cancer Screening (CCS) – Women 21-64 years of age who were screened for cervical cancer. Measure is broken out into 3 possible age and service groups
   • Women 21-64 years of age who had cervical cytology performed in the last 3 years.
   • Women 30-64 years of age who had cervical high-risk human papillomavirus (hr HPV) testing performed within the last 5 years.
   • Women 30-64 years of age who had cervical cytology/hr HPV co-testing within the last 5 years.
     Please note that biopsies do not count to close this measure. Patients may be exempt from this measure if they have had a “complete”, “total”, or “radical hysterectomy” OR “Hysterectomy with no residual cervix”. This must be clearly documented in the patient medical record.
2. Breast Cancer Screening (BCS) – The percentage of Women 50 -70 years of age who had a mammogram to screen for breast cancer in the past 2 years. Patients may be exempt from the BCS measure if they have had any of the following:
   • Bilateral/Complete mastectomy
   • Unilateral mastectomy with a bilateral modifier

For more coding and documentation tips see our HEDIS 2021-2022 Gaps in Care Documentation & Billing Guide for Providers at the following link.

If you have questions, please contact Provider Services at 1.888.936 PLAN (7526).