Insight
HEDIS Task Planning, Quarter by Quarter
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Introduction
Success with the Healthcare Information Effectiveness Data and Information Set—or HEDIS—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—missing screenings, immunizations, or lab results—and coordinate remediation with clinical teams
- Assess supplemental data sources:
Ensure external data sources (e.g., registries, health information exchanges) meet audit requirements.
- 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.
Dive deeper into providers' annual HEDIS maintenance tasks.
Q2: April–June
Goal: Finalize data, lock audits, and prepare for NCQA submission.
- Conduct internal audit readiness reviews:
Assess documentation, processes, and data submission capabilities before the plan lock and final audits. This year's plan lock is May 30, 2025.
- Engage auditors and finalize medical record review (MRR):
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.
Final IDSS submissions and attestations are due to NCQA by June 13, 2025.
Stay on track with this printable HEDIS Annual Planning checklist.
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.
HEDIS success doesn’t happen by accident—it happens with intention. Use this quarterly guide as a roadmap to keep your organization on track and moving forward.