October 2024
HEDIS® is a National Committee for Quality (NCQA) tool used by more than 90% of America’s health plans to measure performance on important dimensions of care and service. One of our primary focus areas is eye exams for members with diabetes, who either don’t have a record of an annual eye exam or have a record of a negative retinopathy in the past 2 years.
We encourage continuity and coordination of care between our member’s eye care providers and primary care providers (PCPs), which is crucial for the member’s overall health and well-being. More than 270 systemic and chronic diseases can be detected during a comprehensive eye exam.1
After every exam, please share the results of the diabetic retinal exam with the member’s PCP. If a significant change is observed in an eye exam of the patient, please call the PCP. The member’s assigned PCP is found on the front of the member’s ID card.
As a reminder, when billing for your patients with diabetes, please use the correct CPT® II and HCPCS codes to meet HEDIS quality care measurements. Billing with appropriate codes reduces administrative burden on your staff. For details on coding for patients with diabetes, you can refer to our Care and coding standards: Diabetes guide, available in the Resources dropdown on providers.eyesynergy.com.
We appreciate your support and together we can improve eye care and overall care for patients living with diabetes. If you have any questions or suggestions, please contact us for further assistance.
1 AOA. See the Full Picture of Your Health with an Annual Comprehensive Eye Exam, 2024.