Companion Benefit Alternatives

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.

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 visit.
  • These services may be through inpatient admission, outpatient visit, intensive outpatient encounter or partial hospitalization, as long as the provider makes an AOD–related diagnosis. 

Antidepressant Medication Management

Patients with major depression remaining adherent to medication

  • Acute Phase – Patient should have at least 84 days of prescription medication dispensed out of the 114 days following initiation of medication management.
  • Continuation Phase – Patient should have at least 180 days of prescription medication dispensed out of the 231 days following initiation of medication management.

    • To assist with compliance, emphasize the need for long-term medication adherence to the member.

    • The need for washout periods while changing medication is accounted for in the timeframes provided. For example, during the acute phase a provider may use 20 days for washout periods, leaving 10 days in which the member may fail to renew a prescription without compromising compliance.

Attention Deficient Hyperactive Disorder (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 – Children continuing their ADHD medication beyond 30 days should visit their doctors twice more within nine months after their initial follow-up visit.

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.