Category: Cinga Insurance

This measure represents the percentage of children who turned 13 years old and received the following immunizations before their 13th birthday.

• One dose of meningococcal vaccine
• One tetanus, diphtheria toxoids and one acellular pertussis vaccine (Tdap): and
• Completed the human papillomavirus (HPV) series.*

*HPV requires 2 shots, at least 146 days apart.

---

Meningococcal recombinant (serogroup B) (MenB) vaccines- DO NOT COUNT towards the HEDIS measure.

---

For Meningococcal Serogroups A, C, W, Y:

• At least one meningococcal serogroups A, C, W, Y vaccine, with a date of service on or between the member’s eleventh and 13th birthdays
• Anaphylaxis due to the meningococcal vaccine any time on or before the member’s 13th birthday meets criteria

---

For Tdap: generic documentation (Tdap/Td) can be counted towards this HEDIS measure.

• At least one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine, with a date of service on or between the member’s tenth and 13th birthdays.
• If patient has anaphylaxis due to Tdap vaccine during or before pt turns 13 years old
• Encephalitis due to the tetanus, diphtheria, or pertussis vaccine

---

For HPV:

• At least two HPV vaccines on or between the member’s ninth and 13th birthdays and with dates of service at least 146 days apart
• At least 3 HPV vaccines – w/ different DOS before or on the date when patient turns 13 years of age
• Anaphylaxis due to the HPV vaccine any time on or before the member’s 13th birthday meets criteria

---

Accepted documentation:

• A note with the specific antigen/vaccine and the date of administration of the vaccine
• A certificate of immunization prepared by an authorized health care provider or agency with information of each vaccine and their administration dates

---

Not accepted documentation:

A note that says the member is up to date and does not have the actual vaccines listed w/ administration dates

---

---

PROVIDERS-some things you can do in your practice in order to meet this measure:

• Have standing orders for adolescent vaccines- the visit can be performed by a Nurse
• Use appointment reminders to schedule vaccine appointments
• For HPV  vaccines make sure to schedule a f/u appt for the next dosage.
• Educate parents on the importance of the vaccines and their on time administration.

---

Find this type of content useful? Follow my blog for more of healthcare industry related content. #medicalcoding #medicalbilling #reimbursement

• UHC to remove prior auth for some radiology and cardiology tests.
• Anthem BCBS NY: New PET tracer UM policy
• PrEP proper billing and coding
• MVP to end its relationship with naviHealth, Inc
• MVP postpartum program incentive payments: NY providers!