Meridian MY 2026 HEDIS Quick Reference Guide - Updated to reflect NCQA HEDIS Measurement Year (MY) 2026 Technical Specifications

Oct 13, 2026

Upload by dhado

Meridian Medicaid, Wellcare Meridian Dual Align (HMO D-SNP), YouthCare, Ambetter, and Wellcare provide an updated HEDIS MY 2026 Quick Reference Guide to support higher HEDIS performance. It explains HEDIS as standardized quality measures used to objectively report and compare care across health plans. The guide details how rates are calculated using administrative and hybrid data, emphasizes correct claim/encounter submission and documentation, and outlines actions to improve scores, including CPT II codes and supplemental data feeds. It also describes Meridian’s Quality Improvement support and lists provider resource expectations and contacts.

LanguageEnglish

CategoryGeneral

FormatPDF

Pages157

Reading Time55 min

AccessFree to download

What is HEDIS?

What Are the Scores Used For?

How Are Rates Calculated?

How Can I Improve My HEDIS Scores?

How Does Meridian’s Quality Improvement Team Support Providers?

Meridian Quality Improvement Resources

Contact Information for Provider Services

Quick Reference Guide HEDIS® MY 2026 Meridian Medicaid Wellcare Meridian Dual Align (HMO D-SNP) YouthCare (Medicaid) Ambetter (Marketplace) Wellcare (Medicare) Electronic Clinical Data Systems (ECDS) HEDIS measure For more information, [visit](visit www.ncqa.org)[ www.ncqa.org](visit www.ncqa.org) HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA) . The HEDIS® measures and specifications were developed by and are owned by NCQA. NCQA holds a copyright in these materials and may rescind or alter these materials at any time. Users of the HEDIS® measures and specifications shall not have the right to alter, enhance, or otherwise modify the HEDIS® measures and specifications, and shall not disassemble, recompile, or reverse engineer the HEDIS® measures and specifications. Anyone desiring to use or reproduce the materials, subject to licensed user restrictions, without modification for an internal non-commercial purpose may do so without obtaining any approval from NCQA. Use of the Rules for Allowable Adjustments of HEDIS® to make permitted adjustments of the materials does not constitute a modification. All other uses, including a commercial use, or any external reproduction, distribution, or publication must be approved by NCQA and are subject to a license at the discretion of NCQA. HEDIS® MY 2026 Quick Reference Guide Updated to reflect NCQA HEDIS® Measurement Year (MY) 2026 Technical Specifications We strive to provide quality healthcare to our membership as measured through HEDIS quality metrics. We created the HEDIS® MY 2026 Quick Reference Guide to help you increase your practice’s HEDIS rates and to address care opportunities for your patients. Please always follow state and/or CMS billing guidance and ensure the HEDIS codes are covered prior to submission. What is HEDIS®? HEDIS® (Healthcare Effectiveness Data and Information Set) is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA) to objectively measure, report, and compare quality across health plans. NCQA develops HEDIS measures through a committee represented by purchasers, consumers, health plans, healthcare providers, and policymakers. What Are the Scores Used For? As state and federal governments move toward more qualitydriven healthcare, HEDIS rates are becoming more important for both health plans and individual providers. State purchasers of healthcare use aggregated HEDIS rates to evaluate health insurance companies’ efforts to improve preventive health outreach for patients. Physician-specific scores are also used to measure your practice’s preventive care efforts. Your practice’s HEDIS score determines your rates for physician incentive programs that pay you an increased premium — for example, Pay for Performance or Quality Bonus Funds. Return to Table of Contents 2 How Are Rates Calculated? HEDIS rates can be calculated in two ways: administrative data or hybrid data. Administrative data includes claim or encounter data and electronic clinical data systems (ECDS) data. ECDS uses data directly from EHRs, claims, and registries, which reduces manual burden and increases efficiency. 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 can reduce the need for medical record review. If services are not billed, not billed accurately, or not shared through electronic data feeds, they are not included in the calculation. How Can I Improve My HEDIS® Scores? • Submit claim/encounter data for each and every service rendered • Make sure that chart documentation reflects all services billed • Bill (or report by encounter submission) for all delivered services, regardless

FAQs

What is HEDIS and who develops it?

HEDIS is a set of standardized performance measures used to objectively measure, report, and compare quality across health plans. NCQA develops the measures through a committee represented by purchasers, consumers, health plans, healthcare providers, and policymakers.

How are HEDIS rates calculated?

HEDIS rates can be calculated using administrative data or hybrid data. Hybrid data combines administrative data with a review of a random sample of member medical records to capture services not reported through claims or encounter data.

What actions can improve HEDIS® scores?

Submit claim/encounter data for every service, ensure chart documentation matches billed services, and submit accurate and timely data. Add CPT II codes when applicable, and implement supplemental data feeds to capture relevant HEDIS data not obtained through claims.

Oct 13, 2026

Upload by dhado