Our member and provider services may be experiencing higher than normal call volumes from 12/22/25-1/9/26 due to a large number of staff being out of office. We encourage you to utilize alternative forms of communication including secured messaging through online Member Services and Availity Essentials Provider Portal.
High call volumes
We are unable to accept walk-ins on Friday, Jan. 2., due to short staffing.
HEDIS® Tip Sheet
Childhood Immunization Status (CIS)
Line of business: BlueAlliance (Commercial)
Measure Description
Percentage of children 2 years of age who had 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 conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday.
Compliant Blood Pressure
Children who received all the following (each row) on or before their second birthday meet criteria.
Note: Compliance can be met with any of the listed criteria for each vaccine (i.e. patient received the vaccine/antigen doses or has a history of the illness or history of the vaccine causing anaphylaxis or encephalitis).
Vaccine | Doses | Combo vaccine or antigen | History of illness | Anaphylaxis r/t vaccine | Encephalitis r/t vaccine | |
DTaP | Diptheria, tetanus, acellar pertussis | 4 | X | X | X | |
IPV | Polio | 3 | X | X | ||
MMR | Measles, mumps, rubella | 1 | X | X | X | |
HiB | Hemophilus influenza B | 3 | X | X | ||
HepB | Hepatitis B | 3 | X | X | X | |
VZV | Varicella zoster (Chicken Pox) | 1 | X | X | X | |
PCV | Pneumococcal conjugate | 4 | X | X | ||
HepA | Hepatitis A | 1 | X | X | X | |
RV | Rotavirus | 2-3 | X | X | ||
Flu | Influenza | 2 | X | X | ||
- Combination 3
- Members who are compliant for DTaP, IPV, MMR, HiB, HepB, VZV and PCV.
- Combination 7
- Members who are compliant for DTaP, IPV, MMR, HiB, HepB, VZV, PCV, HepA and RV.
- Combination 10
- Members who are compliant for DTaP, IPV, MMR, HiB, HepB, VZV, PCV, hHepA, RV and Flu.
Notes
- The measure calculates a rate for each vaccine and three combination rates.
- Do not count a DTaP, IPV, HIB, PCV, or RV vaccine given prior to 42 days after birth.
- MMR, VZV, and HepA must be administered on or between the child’s first and second birthdays.
- For MMR, children must have history of measles, mumps, AND rubella to meet criteria through history of childhood illness.
- For influenza, one of the two vaccines can be a live attenuated influenza vaccine (LAIV) if given on the child’s second birthday.
- For HepB, the first dose can be a newborn HepB.
- The vaccine will not be valid for HEDIS® reporting if given even one day after the second birthday.
Exclusions
- Members on Hospice.
- Members who die any time during the measurement period.
- Members who had a contraindication* to a childhood vaccine on or before their second birthday.
Best Practices
- Coordinate office visits around immunization requirements.
- Set alerts in the EMR to flag when immunizations are due.
- Use office visits as a time to review the immunization schedule and status of your patient.
- Educate parents on the importance of immunizations to protect their child, family, and community from vaccine-preventable diseases.
- Send reminders by email, mail, and text to increase immunization rates.
- Request previous immunization records for new patients.
- If the child should not be immunized because of childhood illness, ensure the information and the date are documented in the medical record.
- Submit claims in a timely manner.
- Report all immunizations through your state immunization registry.
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.
Questions
Should you have specific coding or other questions related to the measure, please send your questions to BlueAlliance@bcbsnd.com.
NCQA Copyright Notice and Disclaimer
The HEDIS® measures and specifications were developed by and are owned by NCQA. The HEDIS measures and specifications are not clinical guidelines and do not establish a standard of medical care. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures and specifications. NCQA holds a copyright in these materials and can rescind or alter these materials at any time. These materials may not be modified by anyone other than NCQA. Use of the Rules for Allowable Adjustments of HEDIS to make permitted adjustments of the materials does not constitute a modification. Any commercial use and/or internal or external reproduction, distribution and publication must be approved by NCQA and are subject to a license at the discretion of NCQA. Any use of the materials to identify records or calculate measure results, for example, requires a custom license and may necessitate certification pursuant to NCQA’s Measure Certification Program. Reprinted with permission by NCQA. © [2025] NCQA, all rights reserved.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Updated 7/16/2025
