 |
|
|
 |
NC Division of Medical Assistance |
|
|
|
The Quality, Evaluation and Health Outcomes Unit (QEHO) has:
Please see the Disclaimers below related to Medicaid data.
The free Adobe Acrobat Reader is required to view and print PDF files.
Since February 2007, the Division of Medical Assistance has only the most recent 72 months (6 years) of claim history data available. As a result, any measures which require claims history for identifying past services are limited to this time frame. For some data sets (such as the HEDIS measures), this data limitation could potentially prevent identification for exclusion from the eligible population. For example, the Cervical Cancer Screening measure relies on claims history to exclude recipients who have had a hysterectomy. By looking back only six years, a recipient may be incorrectly included in the population if the procedure was performed prior to this time.
Through calendar year 2005, North Carolina included recipients dually enrolled in Medicaid and Medicare in its reporting of Medicaid HEDIS results. Many states and Medicaid Managed Care Organizations exclude dual-eligibles from HEDIS reporting and as a result, North Carolina reported rates may not be directly comparable to those of other states. This is particularly true for measures which include enrollees over age 65. Division of Medical Assistance claims may be incomplete for dual-eligible enrollees if billing entities, such as independent laboratories, submit claims only to Medicare. For measures which incorporate laboratory testing (such as A1C and lipid testing rates among diabetics), the reported testing rates may underestimate actual rates.
Effective August 9, 2004, North Carolina implemented an ethnicity code in addition to the race code for the Medicaid population. As part of the conversion, some individuals were assigned an ethnicity code based on their race and Supplemental Security Income (SSI) status. For individuals with insufficient information to define an ethnicity code an "Unreported" ethnicity code was applied, which has resulted in some over reporting of this "Unreported" ethnicity code. As recipients re-enroll into the Medicaid program and this information is updated the ethnicity code may become more reliable over time.
The NC Health Choice (NCHC) Children’s Health Insurance Program (CHIP) member population is not included in the NC Medicaid HEDIS reporting, and any required HEDIS measures are reported separately for CHIP members.
The NC Division of Medicaid’s system for collecting and processing data to produce their annual HEDIS measure reports is not assessed by a HEDIS Compliance Audit evaluation.
