Welcome to Provider's Corner! This section of our website is customized to meet your needs and will include useful tips and ideas for practices and procedures you need to complete for NCQA, Buckeye and Ohio Department of Medicaid requirements. The intent is to create an easy-to-use, one-stop shop with helpful specifics around Quality measures, such as HEDIS, CAHPS and clinical processes you can use to meet the criteria for these requirements. Be sure to bookmark this page to make it easy to return when you need to reference content. We hope you find this helpful and are open to topics you’d like discussed on the site.
HEDIS is a set of performance measures developed by the National Committee for Quality Assurance (NCQA), which holds Buckeye accountable for the timeliness and quality of healthcare services delivered to its diverse membership. Your work to help us track and report on HEDIS measures ensures we are providing the tools and resources to help more members get and stay healthy.
Below are some of the measures we are focusing on this month:
Members ages 18–75 with diabetes (types 1 and 2) who had a retinal eye exam
HEDIS® Improvement Tips:
- A documented note or letter in patient’s chart signed by an eye care provider indicating the ophthalmoscopic exam was completed with date and results.
- A retinal or dilated eye exam done by an eye care professional in the measurement year.
- Set care gap alerts in EMR as a reminder to schedule missing appointments.
- Documented photograph in patient’s chart with date the fundus photography was performed and resulted by an eye care provider.
Members ages 18 to 85 with diabetes (type 1 and type 2) who had received a kidney health evaluation by estimated glomerular fltration rate (eGFR) and a urine albumin-creatinine ratio (uACR) during the measurement year.
HEDIS® Improvement Tips:
- Member must receive both an eGFR and uACR test to meet compliance for the measure.
- Encourage member to be ready to provide sample at visit check in.
- Review medical records prior to visit and remind member to complete lab test ordered.
Children who complete all immunizations on or before child’s 2nd birthday.
HEDIS® Improvement Tips:
- Educate office staff on the importance of scheduling appointments prior to the child reaching 15-or 30-day mark.
- Healthchek Early and Periodic Screening, Diagnostic and Treatment (EPSDT) required services.
- A strong recommendation for vaccination remains the most powerful for compliance with vaccination recommendations. Take time to educate members and their families about common misconceptions concerning vaccinations using easy-to-understand language and handouts.
Adolescents who had the following vaccine series by their 13th birthday:
- Educate office staff to schedule immunizations prior to the child’s 13th birthday.
- Review recommended vaccinations prior to the visit. Educate parents on common misconceptions about vaccinations.
- Recommended HPV for both male and female patients.
For more HEDIS improvement tips, specific measures, codes and exclusions, please visit HEDIS 2025 Provider Reference Guide
- Flu Season
- HEDIS Measures
- CAHPS
- Annual Wellness Visits
- Colorectal Cancer Awareness
- Provider Appointment Standards
- Heart and Nutrition
- Telehealth
- Osteoporosis
