22-040m HEDIS Monthly Care Gap Report Adds Member COVID-19 Vaccine Record
Date: 01/21/22
Use your care gap report to reach out to members who need a COVID-19 vaccine
Providers have a positive impact on helping members overcome vaccine hesitancy when they initiate discussions with their assigned members.
To help providers identify their members who have not received a COVID-19 vaccine, a new measure, Covid-19 Vaccine, was added to the Healthcare Effectiveness Data and Information Set (HEDIS®) Enhanced Care Gap Report. It includes evidence of either partial or complete COVID-19 vaccination at a member level. This status is based on available data sources.
Only members with evidence of at least one dose of a COVID-19 vaccination are included in the report.
Who receives the Enhanced Care Gap Report
The monthly report is sent to the independent practice associations (IPAs) who then distribute them to their primary care physicians (PCPs), or directly to the contracted PCPs through Cozeva®. If an PCP does not receive the report with the addition of COVID-19 vaccination data from their IPA, they should contact the IPA to request it.
How to determine unvaccinated
To identify unvaccinated members, compare the vaccine-eligible members in the enrollment file (> 5 years old) to the Covid-19 Vaccine measure in the Enhanced Care Gap Report. Enrolled members who do not appear on the Covid-19 Vaccine measure have no record of any vaccination. These are the members who need to be contacted about getting their first COVID-19 vaccination.
Providers with access to Cozeva can get lists of unvaccinated members automatically in the platform. For more information about Cozeva, please contact your Provider Engagement representative or visit the Cozeva website. Cozeva is offered free of charge, and you can sign up for an unlimited number of accounts.
Data sources used
The data used for the COVID-19 Vaccine measure in the report is identified from multiple sources with different frequencies, but the primary source of a member’s vaccination status is the California Immunization Registry (CAIR). It is necessary to continue to enter all vaccinations into CAIR in a timely manner.
The vaccination data is refreshed from all available sources and updated monthly in the HEDIS Care Gap report’s Covid-19 Vaccine measure. Data from more sources will be added to future reports as they are identified.
COVID-19 vaccine administration claims
Medi-Cal pays the Prospective Payment System (PPS) rate for COVID-19 vaccines administered during an in-person visit that meets the requirements of a billable office visit. Each dose is separately reimbursable, so you do not have to wait until both doses of the COVID-19 vaccine have been administered to submit a claim.
Guidance for FQHCs and RHCs
For Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), payment for your vaccine administration is included in your visit rate1. If you only do the COVID-19 vaccine administration, you need to bill the Department of Health Care Services (DHCS) Fee-For-Service Medi-Cal2 directly and not submit a claim to Health Net.
Additional information
Providers are encouraged to access California Health & Wellness Plan’s (CHWP) provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CHWP at 877-658-0305.
1 California Primary Care Association
2 Department of Health Care Services Bulletin