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Hints for HEDIS® (and more)
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, OB-GYN +1 more·Physician
Effective date
Aug 1, 2021
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island updated guidance for HEDIS breast cancer screening quality measures for women ages 50-74. The policy clarifies documentation requirements for mammograms and provides best practices for providers to ensure proper screening compliance and billing.
Action Required
Providers should ensure mammogram documentation includes the date of mammogram and proof of completion (results or findings) rather than just orders. Billing team should verify that all mammogram types (screening, diagnostic, film, digital, digital breast tomosynthesis) are properly documented. Do not count biopsies, breast ultrasounds, or MRIs toward HEDIS compliance. Develop standing orders and automated referrals for women ages 50-74 and follow up to verify completion.