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SECTION 1: REPORTING HEDIS AND CAHPS DATA

SECTION 1: REPORTING HEDIS AND CAHPS DATA 2025

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The 2019 FEHB Plan Performance Assessment Procedure Manual outlines the reporting requirements and procedures for FEHB Carriers regarding Clinical Quality, Customer Service, and Resource Use (QCR) measures, as well as HEDIS and CAHPS data collection. It details the responsibilities of carriers in submitting audited results, timelines for reporting, scoring methodologies, and corrective action plans for underperformance. The manual serves as a comprehensive guide to ensure compliance with OPM standards and improve health plan performance.

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Click ‘Get Form’ to open SECTION 1: REPORTING HEDIS AND CAHPS DATA in the editor.
Begin by reviewing the OPM General Requirements for HEDIS Collection and Reporting. Ensure you understand the data submission process outlined by NCQA.
Fill in the required fields regarding your health plan options, ensuring that you report on the book(s) of business where FEHB members are enrolled.
If applicable, indicate if your organization is a new FEHB Carrier and note that HEDIS and CAHPS data must be reported in your second full year of participation.
Complete the sections related to HEDIS Cost, Timeline, and any specific requirements for CAHPS collection and reporting as per the guidelines provided.
Review all entries for accuracy before submitting. Utilize our platform's features to save your progress and make edits as needed.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the difference between HEDIS and Cahps?

HEDIS data, unlike CAHPS data, do not contain the patients self-reported race/ethnicity. Therefore, race/ethnicity was imputed for the HEDIS data using a methodology that combines information from administrative data, surname, and residential location (Martino et al., 2013).

How to report HEDIS measures?

All health plans submitting HEDIS data must complete the Healthcare Organization Questionnaire (HOQ) to request a submission. Plans that submit the HOQ will have automatic access to the Interactive Data Submission System (IDSS) that NCQA uses to collect non-survey HEDIS data.

Is CAHPS part of HEDIS?

HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program.

What type of data does HEDIS represent?

The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of U.S. health plans to measure performance on important dimensions of care and service.

What are the two main parts to the HEDIS compliance audit?

The audit is in two parts: evaluating a plans overall information systems capabilities (the IS standards) and evaluating a plans ability to comply with HEDIS specifications (the HD standards).

What is the purpose of CAHPS?

The Agency for Healthcare Research and Qualitys (AHRQ) Consumer Assessment of Healthcare Providers and Systems (CAHPS) program began in 1995. Its purpose is to boost our scientific understanding of patient experience with healthcare as part of a larger effort to advance the delivery of safe, patient-centered care.

What are two types of HEDIS measures?

HEDIS Measures Access/Availability of Care. Experience of Care. Utilization and Risk Adjusted Utilization.

SECTION 1: REPORTING HEDIS AND CAHPS DATA 2025

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