- (1) Each carrier shall compile and submit HEDIS data for the preceding calendar year to the program by July 1 of each year.
- (2) By January 1 of each year, each carrier shall submit to the department a plan for creating and providing HEDIS data for the preceding calendar year.
(3)(a) Before submitting data to the department, each carrier shall contract with an independent audit agency certified by the National Committee for Quality Assurance (NCQA) to verify the HEDIS data.
- (b) The independent audit agency shall verify the HEDIS data using NCQA HEDIS Specifications referenced in Subsection R428-1-4(3).
- (4) Each carrier may use the rotation strategy for HEDIS measures developed and updated by NCQA and included in the NCQA HEDIS Specifications.
- (5) If a carrier presents Not Reported (NR) for a required measure, it must document why it did not report the required measure.
- (6) By August 15 of the submission year, each carrier shall require its contracted audit agency to submit a copy of the audit agency's final report to the department. The final report shall incorporate the carrier's comments.
KEY: health, health planning, health policy
Date of Last Change: January 16, 2025
Notice of Continuation: May 31, 2022
Authorizing, and Implemented or Interpreted Law: 26B-8-501.1