CommercialDocumentationMedium impact
AB2026-06-002 Quality information
Capital Blue Cross·Endocrinology, Family Medicine, Internal Medicine +3 more·Provider News
Effective date
Jun 1, 2026
We identified it
Jun 20, 2026
Summary
Capital Blue Cross updated HEDIS quality measure requirements for three diabetes-related screenings: eye exams (EED), glycemic status assessment (GSD), and kidney health evaluation (KED). This administrative bulletin clarifies documentation requirements, acceptable test types, and exclusion criteria for diabetic patients aged 18-85.
Action Required
Immediately: Review current diabetes patient documentation to ensure compliance with updated HEDIS measures. Billing team must verify that diabetic eye exams clearly document dilated or retinal exams by eye care professionals with specific retinopathy findings (not just 'diabetes without complications'). Update EMR templates to include reminder flags for annual eGFR and uACR testing for diabetic patients. Utilize monthly action report files and Theon reporting system to identify and close gaps in diabetes care measures.