HEDIS Quick Reference Guide 2025
Date: 04/15/25
The Nebraska Total Care HEDIS® Quick Reference Guide 2025 (PDF) is now available. Learn more about HEDIS® (Healthcare Effectiveness Data and Information Set).
Nebraska Total Care strives to provide quality healthcare to our membership as measured through HEDIS® quality metrics. We created the HEDIS® Quick Reference Guide 2025 (PDF) to help you increase your practice’s HEDIS® Rate. Please always follow the State and/or CMS billing guidance and ensure the HEDIS® codes are covered prior to submission.
HEDIS® rates can be calculated in two ways: administrative data or hybrid data. Administrative data consists of claim or encounter data submitted to the health plan. Measures typically calculated using administrative data include: annual mammogram, annual Chlamydia screening, annual pap test, treatment of pharyngitis, treatment of URI, appropriate treatment of asthma, cholesterol management, antidepressant medication management, access to PCP services, and utilization of acute and mental health services. Hybrid data consists of both administrative data and a sample of medical record data. Hybrid data requires review of a random sample of member medical records to abstract data for services rendered but that were not reported to the health plan through claims/encounter data. Accurate and timely claim/encounter data reduces the necessity of medical record review. Measures typically requiring medical record review include: comprehensive diabetes care, control of high-blood pressure, immunizations, prenatal care, and well-child care.
HEDIS® Adult Pocket Guide 2025 (PDF)
HEDIS® Pediatric Pocket Guide 2025 (PDF)
Please contact your Quality Practice Advisor or Provider Relations if you have further questions.