Frequently Asked Questions

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What are the engagement expectations (e.g. missed appointments)?

Providers should look closely at program specific requirements and contracts with managed care organizations for engagement expectations.

Source: RCM/UM/Outcomes Event: Albany 5.29.15

Is there a way to find out what the Healthcare Effectiveness Data and Information Set (HEDIS) measures are going to be?

HEDIS scores are national quality measures and there are now, through CMS, penalties for not meeting certain HEDIS scores in physical health. Eventually that penalty will affect the behavioral health side as well. Most likely managed care organizations will be interested in behavioral health readmission, 7 and 30 day follow-up, and a medication adherence quality measure.

For more information on HEDIS, please go here. The 2018 HEDIS measures can be found here.

Source: Contracting