All PlansAdministrativeMedium impact
Quality Measures Track Treatment and Follow-Up Visits for Substance Use Disorders
BCBS Illinois·IL · Psychiatry, Family Medicine, Internal Medicine +2 more·General
Effective date
Mar 4, 2026
We identified it
Jun 16, 2026
Summary
This policy establishes HEDIS quality measures for tracking substance use disorder treatment and follow-up visits for members ages 13 and older. It provides guidance on required timeframes for treatment initiation, engagement, and follow-up after ED visits or high-intensity care, plus tracking of opioid prescribing patterns.
Action Required
By March 4, 2026: Providers should ensure consistent use of substance use disorder diagnosis codes at all follow-up visits, coordinate care between behavioral health and primary care providers, and document progress notes that include SUD diagnoses. Billing team should verify that follow-up visits are scheduled within required timeframes (7-14 days for initiation, 30-34 days for engagement) to support quality measure reporting.