This communication applies to the Commercial and Medicare Advantage programs from Anthem Blue Cross and Blue Shield (Anthem).

 

HEDIS® measurement year 2023 documentation for Childhood Immunization Status (CIS)

 

Measure description: The percentage of children who turn 2 years of age in the measurement year who had the following vaccines on or before their second birthday:

  • Four DTaP (diphtheria, tetanus, and acellular pertussis)
  • Three IPV (polio)
  • One MMR (measles, mumps, and rubella)
  • Three HiB (haemophilus influenza type B)
  • Three hep B (hepatitis B)
  • One VZV (chicken pox)
  • Four PCV (pneumococcal conjugate)
  • One hep A (hepatitis A)
  • Two or three RV (rotavirus)
  • Two flu (influenza)

 

The measure calculates a rate for each vaccine and three combination rates.

 

HEDIS measurement year 2023 documentation for Lead Screening in Children (LSC)

 

Measure description: The percentage of children 2 years of age who had one or more capillary or venous lead blood test for lead poisoning by their second birthday.

 

In provider medical records, we look for the following:

  • Immunization records from birth (Department of Health immunization records are acceptable).
  • If available, newborn inpatient records documenting hepatitis B.
  • For immunizations not recorded on the immunization record, provide progress notes for:
    • Immunizations administered.
    • Patient’s history of disease (chickenpox, hep A, hep B, measles, mumps, rubella).
  • Lead testing results and date (capillary or venous) on or before the second birthday.
  • Evidence of hospice services in 2023.
  • Evidence patient expired in 2023.

 

Helpful hints:

  • Childhood immunizations and lead blood tests must be completed by child’s second birthday.
  • Assess immunization needs at every clinical encounter and, when indicated, immunize.
  • Ensure immunization records include all vaccines that were ever given including hospitals, health departments, and all former providers, including refusals and contraindications.
  • FluMist (LAIV) vaccination (only approved for ages 2 to 49) may be used for the second vaccination; however, it must be given on the child’s second birthday to be compliant.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
MULTI-BCBS-CRCM-012261-22-CPN11878



Featured In:
January 2023 Anthem Provider News - Colorado