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HEDIS Quality Measures Coding

Developed by the National Committee for Quality Assurance (NCQA), HEDIS is the gold standard for healthcare quality. V1RCM helps health plans and provider networks close care gaps and boost Star Ratings.

Year-Round HEDIS Tracking & Medical Record Abstraction

HEDIS season shouldn't be a frantic annual scramble. Our dedicated quality coding pods work year-round to abstract clinical records, match administrative claims data, and ensure every quality milestone is compliant with NCQA technical specifications.

From colorectal and breast cancer screenings to comprehensive diabetes care and blood pressure control, we ensure all necessary clinical documentation is validated, captured, and reported.

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Key HEDIS Domain Expertise

  • Effectiveness of Care: Chronic condition monitoring (HbA1c control, hypertension, asthma medications).
  • Preventive Screenings: Mammography, cervical cytology, lead screening, and adult immunizations.
  • Behavioral Health: Follow-up after emergency visits for mental illness and substance use disorders.
  • Medical Record Abstraction (MRRV): Rigorous over-read audits to maintain ≥ 98% inter-rater reliability.