June 30, 2023
Many children missed routine childhood immunizations and well-child visits during the last several years, according to the Centers for Disease Control and Prevention. The CDC recommends providers and health care professionals encourage families to schedule vaccines and visits to help children catch up. See our Children’s Wellness Guidelines for a routine immunization schedule.
Tracking Our Members’ Care
We track these Healthcare Effectiveness Data and Information Set (HEDIS®) measures developed by the National Committee for Quality Assurance to help close gaps in our members’ care:
Child Immunization Status tracks the percentage of 2-year-olds who received the following vaccines by their second birthday:
- Four diphtheria, tetanus and acellular pertussis (DTaP)
- Three polio (IPV)
- One measles, mumps and rubella (MMR)
- Three haemophilus influenza type B (HiB)
- Three hepatitis B (HepB)
- One chicken pox (VZV)
- Four pneumococcal (PCV)
- One hepatitis A (HepA)
- Two or three rotavirus (RV)
- Two flu vaccines
Immunizations for Adolescents tracks the percentage of 13-year-olds who received by their 13th birthday:
- One dose of meningococcal vaccine
- One tetanus, diphtheria and pertussis (Tdap)
- The complete human papillomavirus vaccine (HPV) series
Child and Adolescent Well-Care Visits
- Well-Child Visits in the First 30 Months of Life measures the percentage of children who had at least six well-child visits with a primary care physician during their first 15 months, and two or more well-child visits during their next 15 months
- Child and Adolescent Well-Care Visits tracks the percentage of children ages 3 to 21 who received at least one well-care visit with a PCP or OB/GYN during the measurement year
Tips To Consider
- Identify members who have missed vaccines or well-child visits. Contact their caregivers to schedule appointments.
- Check at each visit for any missing immunizations. Address common misconceptions about vaccines.
- To document well-child visits, note that the visit was with a PCP and include in the medical record date of visit; health history; physical and mental development history; physical exam; height, weight and body mass index percentile; health education or anticipatory guidance, including physical activity, diet and nutrition.
We collect immunization data through claims and chart review. To document immunizations, you may include in the medical record any of the following: certificates of immunizations; diagnostic reports; Subjective, Objective, Assessment and Plan (SOAP) notes; office or progress notes.
Resources
- BCBSIL preventive care guidelines on immunization schedules.
- Information on childhood vaccines and well-visits for our members.
- CDC recommendations on COVID-19 vaccines and boosters for children and teens.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.
Information provided by BCBSIL is for informational and educational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider, nor is the information presented intended to replace or supersede any requirements set forth in your contract with BCBSIL. Any samples in this communication are for illustrative and/or educational purposes only and should not be relied on in determining how a specific Provider will be reimbursed. In the event of a conflict between the information in this presentation and your contract, your contract will control.
The information provided does not constitute coding or legal advice. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment.
HEDIS is a registered trademark of NCQA.