HEDIS® Tip Sheet

Adults Access to Preventive/Ambulatory Health Services

Line of business: BlueAlliance Care+ (Medicaid)

Measure Description

The percentage of members 20 years of age and older who had an ambulatory or preventive care visit during the measurement year.

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  • Health care visits are an opportunity for members to receive preventive services and counseling on topics such as diet and exercise.
  • Visits can also help address acute issues or manage chronic conditions.
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Services include

  • General medical exams.
  • Annual wellness visits.
  • Preventative physical exams.
  • Hospital outpatient clinic visits.
  • Clinic visit/encounters.
  • Evaluation and management (E/M) visits.
  • Office consultations.
  • Preventive medicine counseling services.
  • Routine ophthalmological examinations.
  • Online E/M services.
  • Telephone assessment and management services.
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Best Practices

  • Educate patients and providers on the importance of annual preventative care visits.
  • Schedule the next appointment at completion of current visit.
  • Establish and utilize a patient self-scheduling platform.
  • Provider/staff education and consistent messaging on the need to monitor patients in need of preventive care visits and make recommendations to schedule.
  • Utilize EMR reporting and patient flags for those in need of preventive care visits.
  • Contact patients to remind them of upcoming appointments.
  • Keep some appointment slots open each day to allow for same day visits. 
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  • Members in hospice during the measurement year.
  • Member who died during the measurement year. 

Coding Disclaimer

The analysis of any medical coding question related to a measure is dependent on the measure’s technical specifications including the factual situations present related to the member, the practice, the professionals, and the medical services provided.


Should you have specific coding or other questions related to the measure, please send your questions to BlueAlliance@bcbsnd.com.


HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).