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).

  • 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.
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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.
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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.
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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.

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