All PlansDocumentationMedium impact
New tip sheet available for the Behavioral Health HEDIS measure: Follow-Up Care for Children Prescribed ADHD Medication (ADD)
UPMC Health Plan·Pediatrics, Psychiatry, Pharmacy·Pharmacy
We identified it
Aug 7, 2026
Summary
UPM Health Plan has released a new tip sheet clarifying HEDIS measure requirements for follow-up care of children ages 6-12 newly prescribed ADHD medication. The policy requires a minimum of three appointments (initial prescriber visit plus two subsequent treatment team visits) within 10 months of starting medication. This is a quality measurement and care coordination guideline, not a billing code change.
Action Required
Immediately: Pediatric and behavioral health providers must review the new ADD HEDIS tip sheet and ensure documentation processes capture all three required appointments within the 10-month window. Billing team should: (1) Coordinate with clinical staff to verify appointment scheduling compliance for pediatric ADHD cases, (2) Ensure claims include appropriate visit dates and provider types to demonstrate measure compliance, (3) Flag claims for children 6-12 newly prescribed ADHD medication to track the three-visit requirement for quality reporting purposes. Update encounter templates and scheduling systems to support tracking of initial and follow-up behavioral health appointments. Non-compliance with this quality measure may impact plan performance metrics and future reimbursement arrangements, though it does not directly affect individual claim denials.