For Providers

Quality Improvement Program

HEDIS®
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Horizon NJ Health’s Continuous Quality Improvement program uses HEDIS (Healthcare Effectiveness Data and Information Set) measures that the National Committee for Quality Assurance (NCQA) established. The NCQA created HEDIS as tool to collect data about the quality of care and services provided by the health plan. This set of standardized measures compares health plans’ performance on important dimensions of care and service. HEDIS is recognized as one of the most proven forms of methodology for data collection and the most widely used set of performance measures in the managed care industry. HEDIS results are based on a statistically valid random sample of members or the entire eligible population.

Horizon NJ Health Providers play a critical role in the delivery of healthcare, assisting us in ongoing quality initiatives by outreach to and educating our members. By communicating with our members the importance of preventive health screenings and age-appropriate exams, providers can help us increase HEDIS scores.

Interactions that focus on the value of preventive care are instrumental in encouraging patients to obtain preventive screenings, such as lead testing, PAP smears, mammography and colonoscopy. All are important services that you can provide to your patients, our members. When you see one of your Horizon NJ Health patients, you have the opportunity to reinforce good health care behavior on topics, such as child development, safety issues appropriate to each age group or disease education. We continue to increase our interactions with members to improve preventive care compliance and recognize that enhanced interactions between provider and member will assist in improving our members’ health outcomes, ultimately and positively impacting our HEDIS rates.

Please document all components of the member’s visit in his or her medical record. As a reminder, please submit encounters for visits in the form of claims. This will assist us when we are performing our audits including HEDIS. Encounter submissions will assist in increasing HEDIS scores.