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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

Analytical Studies

Analytical Studies is part of the Business Information Office (BIO) team which incorporates and coordinates data into everday practice and processes at the N.C. DHHS Division of Medical Assistance.

Most of the statistics and reports are in Adobe Acrobat Reader PDF format. The free Adobe Acrobat Reader is required to view and print PDF files.

County Specific Snapshots for N.C. Medicaid Services

DMA HEDIS (Healthcare Effectiveness Data and Information Set) Reporting

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DMA HEDIS Data

 

Analytical Studies Disclaimers

Claim History Availability

On July 1, 2013 the NC DHHS Division of Medical Assistance transitioned to NC Tracks, a new Medicaid Management Information System, for claims processing.  At that time Medicaid administrative claims data was loaded with five years of claim data.  Production data will eventually include ten years of claim data on a rolling basis.

Dual-Eligibles

Recipients dually enrolled in both NC Medicaid and Medicare are excluded from the Medicaid HEDIS reporting because DMA claims may be incomplete for dual-eligible enrollees.  As a result some reported NC HEDIS rates may not be comparable to those of other states, particularly for measures which include enrollees over age 65

Race and Ethnicity

Race and ethnicity codes are determined when recipients enroll into the NC Medicaid program.  For individuals with insufficient information to define a race or ethnicity code the “Unreported” code is applied.

NCHC CHIP Population

The NC Health Choice (NCHC) Children’s Health Insurance Program (CHIP) member population is not included in the NC Medicaid HEDIS reporting, and any required HEDIS measures are reported separately for CHIP members.

CareAnalyzer HEDIS Reporting

Effective with HEDIS 2012 reporting NC Medicaid is utilizing CareAnalyzer, NCQA certified software, for production of its HEDIS reporting.  CareAnalyzer is a browser-based analytic tool that combines elements of patient risk, care opportunities and provider performance to meet HEDIS reporting requirements.

 

 

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