How is "compliant" characterized in HEDIS?

In HEDIS, "compliant" is primarily characterized by claims data that meet specific HEDIS specifications. This compliance is crucial for evaluating the quality of care provided by health plans and healthcare providers. It emphasizes using standardized measures that allow for the comparison of care quality across different organizations. Compliance with these specifications ensures that the data accurately reflects adherence to clinical guidelines and performance metrics established by HEDIS.

The focus on claims data is essential because it provides a robust mechanism for assessing healthcare delivery without requiring direct patient interaction at the time of data collection. This form of compliance allows organizations to gather measurable outcomes based on service utilization, outcomes achieved, and adherence to treatment plans that HEDIS outlines.

Understanding this context helps clarify why claims data are fundamental to HEDIS' mission of promoting quality care and improvement across the healthcare system.