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Attachment #1: Examples of Encounter Data
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Health Plan ID
Beneficiary ID
Date of Service
Place of Service
Provider Name
Provider Number
Prior Authorizations
Referrals
Diagnosis Codes
Procedure Codes
Medications/Prescriptions
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Surgical Codes
Admission Dates
Discharge Dates
Patient Status Code
Long-term care
Number of days
X-Rays and Imaging
Laboratory Services
“What diagnosis was made?
What tests were performed?
What treatments were provided?”
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Attachment #2: HEDIS Measurements
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Well-Child Visits (Years 3-6)
Adolescent Well-Care Visits
Childhood Immunization StatusCombo 3
Prenatal & Postpartum Care
(Timeliness of Prenatal Care,
Postpartum Care)
Use of Imaging Studies for Low
Back Pain
Cervical Cancer Screening
Weight Assessment & Counseling
for Nutrition & Physical Activity for
Children & Adolescents
Comprehensive Diabetes Care
(e.g. Eye exam, LDL-C screening
& control, HbA1c testing & control,
medical attention for Nephropathy,
blood pressure)
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Avoidance of Antibiotic Treatment
in Adults with Acute Bronchitis
HbA1c Testing indicator used for
Auto Assignment (Diabetes)
Children & Adolescents' Access to
Primary Care Practitioners*
Immunizations for Adolescents*
Ambulatory care: Outpatient visits,
Emergency Department visits*
Annual Monitoring for Patients on
Persistent Medications (w/out
anticonvulsant indicator)*
All-Cause Readmissions Statewide Collaborative QIP
measure*
* New for 2012