Blue Review
A Medicaid Provider Newsletter

December 2017

Childhood Immunization Status for HEDIS® 2018

Childhood Immunization Status will continue to be audited during the upcoming Healthcare Effectiveness Data and Information Set (HEDIS) season. The following is a guide to the components of that measure and what information is required for a successful audit:  

Required vaccines on or before a child’s second birthday:

  • 4 Diphtheria, Tetanus and acellular Pertussis (DTaP)
  • 3 Polio (IPV)
  • 1 Measles, Mumps and Rubella (MMR)
  • 3 Haemophilus influenzae type B (HiB)
  • 3 Hepatitis B (HepB)
  • 1 Chicken pox (VZV)
  • 4 Pneumococcal Conjugate (PCV)
  • 1 Hepatitis A (HepA)
  • 2 or 3 Rotavirus (RV)
  • Rotarix (RV1) 2 doses
  • RotaTeq (RV5) 3 doses
  • 2 Influenza* (Flu)

The following vaccines must be given to a child 42 days or later** after their birth to be compliant for the HEDIS audit:

  • DTap
  • IPV
  • RV
  • HIB
  • PCV

Documentation must include the name of the specific antigen and the date of the immunization. The Certificate of Immunization must also be prepared by an authorized health care provider or agency, including the specific dates and types of immunizations administered. “Vaccines up to date” is not acceptable.

Common errors in this measure are:

  • Immunizations given after the second birthday (even one day after cannot be included)
  • Two doses of RV1 and RV5 when used in combination, instead of three
  • Only one flu vaccine given instead of the required two doses before the 2nd birthday

As a health care provider, you are aware of the misconceptions that many parents have about the safety and efficacy of immunizations. Having the latest informational resources available and taking a few minutes to educate them can have a huge influence on the decisions they must make on such an important topic. Here is some information you can distribute to your patients.

Thank you for your partnership and continued education to patients and their families for the prevention of these diseases.

* Influenza may not be given prior to 6 months of age.
**These vaccines cannot be given earlier than 42 days after a child is born. They must be given after day 42 of life and before the second birthday.
HEDIS is a registered trademark of NCQA.