iCare Health Solutions is currently conducting live agent outreach to contracted insurance companies who have diabetic members that are non-compliant for having their diabetic retinal exams.
These members may be scheduling an appointment with you directly as a result of messaging they’ve received from their insurance company, primary care physician, or us. They may also be transferred from an iCare Call Center representative to your receptionist for scheduling.
Why is there an increased need for diabetic retinal exams? It all comes down to HEDIS. Healthcare Effectiveness Data and Information Set (HEDIS) is something you of which all eye care providers should be aware. It greatly impacts:
- Individuals diagnosed with diabetes
- Health care providers
- Insurance companies
The Healthcare Effectiveness Data and Information Set (HEDIS) is a measurement tool created by the National Committee for Quality Assurance (NCQA). This tool is made up of a standardized set of performance measures that determine how well each health plan provides preventative care, treatment, and even customer service.
One of these HEDIS performance measures is comprehensive diabetes care. Since more than 90% of all U.S. health plans use HEDIS, virtually all insurance companies need to make certain they meet the diabetes care measurement expectations.
Encouraging people with diabetes to get preventative diabetic retinopathy (DR) screenings is one way to do just that.
Top Reasons Insurance companies encourage Diabetic Retinopathy Screenings:
- Diabetic’s doctors get the necessary information to help prevent or slow down diabetic retinopathy.
- People with diabetes have the opportunity to have healthy eyesight throughout their lives.
- People with diabetes have freedom from paying for further, more complicated treatments if the diabetic retinopathy isn/t caught early on.
What You Can Do Now:
- Review your patient population for diagnosed diabetics and reach out to them to ensure they receive their annual eye exam.
- Share this information with your colleagues and administrative staff.
- Review your patient documentation to confirm it complies with current HEDIS requirements. Click Here to Review Patient Chart Requirements.
For assistance with any questions regarding HEDIS, please contact: