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Frequently Asked Questions Insurance

How does OPM choose relevant Healthcare Effectiveness Data and Information Set (HEDIS) national commercial benchmarks?

As noted in previous carrier letters, OPM evaluates FEHB health plan HEDIS metrics against relevant national commercial benchmarks. When filing HEDIS 2014 results with the National Committee for Quality Assurance (NCQA), please designate your reporting product (HMO, PPO, HMO/POS) according to your relationship with NCQA. Changes in reporting product with NCQA will not assist in the attainment of Exemplary and/or Most Improved awards in the year the change is made.

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