Insight
HEDIS Task Planning, Quarter by Quarter
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Introduction
Success with the Healthcare Effectiveness Data and Information Set —or HEDIS®¹—requires careful planning and year-round attention. By aligning your team's efforts with the natural rhythm of the HEDIS calendar, you’ll be better positioned to meet reporting deadlines, avoid costly rework, and drive year-over-year improvement. Use this quarter-by-quarter guide to stay organized, align with NCQA deadlines, and keep your value-based care efforts on track.
Q1: January–March
Goal: Prepare systems, teams, and data for the HEDIS reporting cycle.
- Validate claim mappings:
Validate coding accuracy (e.g., ICD-10, CPT, LOINC) used in measure calculations. Ensure accuracy of mappings from claims to HEDIS measures in alignment with current NCQA specifications before loading data into the IDSS.
- Optimize patient attribution logic:
Confirm patients are accurately assigned to providers and care teams to reflect responsibility for care and are aligned with payer or internal attribution models.
- Audit and correct care gap data:
Run mock reports to identify data quality issues like missing screenings, immunizations, or lab results and coordinate remediation with clinical teams
- Assess external and clinical data sources:
Confirm that EHR, HIE, registry, laboratory, pharmacy, case-management, and other data sources meet the requirements of the applicable traditional or ECDS reporting method.
- Develop a submission project plan and timeline
Align internal teams and vendors on deliverables, milestones, and submission responsibilities. Build in time for dry runs and audit remediation.
Review NCQA technical updates.
Review the March technical update, revised value sets, medication lists, risk-adjustment tables, audit guidance, and final measure-retirement decisions. Revalidate affected measure logic and data mappings.
Dive deeper into providers' annual HEDIS maintenance tasks.
Q2: April–June
Goal: Finalize data, complete audit review, apply plan lock, and prepare for NCQA submission.
- Conduct internal audit readiness reviews:
Assess documentation, processes, and data submission capabilities before the plan lock and final audits.
- Engage auditors and finalize medical record review (MRR):
For measures that permit hybrid reporting, ensure abstraction is complete and fully documented. Respond to auditor queries quickly to avoid delays in Plan Lock or submission.
- Submit and validate HEDIS data on time:
Work with auditors to complete final submissions and attestation of results.
Q3: July–September
Goal: Reflect, retool, and review measure updates.
- Review final audit reports and identify improvement areas:
Analyze auditor feedback and submission outcomes to plan performance improvement.
- Update HEDIS reporting periods and measure versions:
Implement NCQA’s updated specifications released in early August to prepare systems for next year’s cycle.
- Benchmark and trend performance
Compare year-over-year measure trends, identify systemic documentation or coding issues, and evaluate alignment with value-based care goals.
Learn how Valleywise Health deployed an actionable HEDIS scorecard to monitor program execution.
Q4: October–December
Goal: Plan ahead and educate staff.
- Identify training gaps and educate staff on HEDIS changes:
Conduct education and training based on upcoming measure updates or performance shortfalls.
- Review payer contracts and value-based agreements:
Reassess contracts to understand HEDIS expectations and financial implications.
- Pre-load test data (if feasible)
Prepare systems to run early test extracts or mock submissions to identify data completeness or errors in logic application.
Advance digital HEDIS readiness.
Assess FHIR and CQL capabilities, structured clinical-data availability, EHR and HIE connectivity, data quality, source-data validation, and readiness for parallel digital reporting.
HEDIS is moving to fully digital quality measurement by MY 3020, so Tegria recommends developing a plan to reduce dependence on manual record review before the Hybrid method is eliminated in MY 2029. Use this quarterly guide as a roadmap to keep your organization on track and moving forward.
- HEDIS® is a registered trademark of the National Committee for Quality Assurance. FHIR® is a registered trademark of Health Level Seven International.