Providers
Best Practices
We use the Healthcare Effectiveness Data and Information Set (HEDIS) standardized performance measures. These measurements evaluate and enhance the quality of mental health and substance abuse care our members receive. More than 90 percent of health plans use HEDIS to measure performance on important aspects of care and service.
We appreciate the quality of care our network providers give to our members. Please encourage members to receive follow-up care within these HEDIS timeframes.
ADHD: Three visits within 10 months.
- Initiation Phase – Children with new ADHD medication prescriptions should have follow-up visits with their doctors within 30 days of starting the medications.
- Maintenance Phase – These children should visit their doctors twice more within nine months after their initiation phases.
Alcohol & Other Drug (AOD) Dependence: Three visits within six weeks.
- Initiation Phase – Newly diagnosed patients with AOD dependence should have a follow-up visit within 14 days.
- Engagement Phase – These patients should have at least two additional AOD services within 30 days after the initiation phase.
Antidepressant Management: Four visits within 12 weeks.
- Acute Phase – Newly diagnosed patients should have at least three follow-up visits within 12 weeks. At least one of the follow-up visits should be with a provider who can write prescriptions.
Follow Up After Hospitalization: One visit within seven days of discharge.
- After a mental health admission, patients should see a behavioral health provider within seven days of discharge.
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