Stars Customer Summary Report abbreviations reference guide
This reference guide provides an explanation for each abbreviation that appears in the Stars Customer Summary Report and other Stars reporting.
Additional information
If you have any questions, about Stars reporting, contact your Provider Performance Enablement representative.
Operational or administrative measures make up 29 percent of the overall Star rating.
CMS collects administrative data related to health plan service capabilities and performance through:
Quality improvement measures
CMS measures a health plan’s or drug plan’s year-over-year improvement or decline through the quality improvement measures. The Part C and Part D improvement measures are derived through comparisons of a contract’s current and prior year scores for certain measures. For a measure to be included in the improvement calculation, the measure must not have had a significant specification change during those years.
Quality improvement measures may contribute to up to 10 percent of the overall Star rating.
Form CMS-1500 and the X12-837P transaction (electronic format) allow providers to submit a maximum of 12 diagnosis codes in a single claim to report active chronic and acute diagnoses. However, there are times when you will want to report additional codes. The procedure is as follows:
We encourage providers to submit additional codes, when supported by medical record documentation, because it will give CMS a more accurate picture of the breadth of services and treatments provided to patients, particularly for complex cases. In addition, it can impact quality reporting for CMS and HEDIS metrics, as well as diagnosis coding for risk adjustment.
For 837P submissions, file a claim as you normally would, but be sure to include the following:
We monitor and aggregate HEDIS data for each of our customers based upon information that is received by providers. However, a portion of these HEDIS metrics can be difficult to calculate without relevant information from the services you provide to your patients.
The exchange of this information is good for you and your patients. Our goal is to house the most real-time and accurate data possible so that we can share insights with you to guide your clinical best practices and preventive services for your patients at the appropriate time. By sending this information to us, your patient outreaches and interventions can be prioritized based on actual needs and not data inaccuracies. Additionally, providers who participate in value-based programs can receive financial incentives that reflect accurate data.
You can help us close gaps by submitting data through one of these methods.
Data that providers submit gives us the necessary information to close Star measure gaps, or ensure that a customer is compliant for certain Star measures for which they are eligible.
You can also send medical record documentation of gap closure via email to FAXHEDISCENTRAL@CignaHealthcare.com or via fax to 877.440.9344, or upload them through the appropriate link listed below:
Records submitted through this method will also be assessed for prioritization and data capture as resources allow, depending on volume and potential impact of incoming records. Records should be submitted as soon as possible and no later than the first week of December to increase likelihood of review.
How HEDIS Hybrid metric reporting affects Star ratings.
HEDIS metrics that are often lagging in data completeness are known as HEDIS Hybrid metrics. The hybrid reporting method calculates measures rates based on claims/encounter, supplemental data, and medical records. The HEDIS rate is made up of claims data as the primary source. Supplemental and hybrid data add to the compliance rate for each measure. The goal is to maximize the “true” rate by gathering data throughout the measurement year. As supplemental data increases, Medical Record Review (MRR) opportunity decreases.
The annual MRR project is the final opportunity to capture “missing” data for hybrid HEDIS measures. The MRR project launches in early February and ends in early May for prior year dates of service.
Each payer with a Medicare Advantage contract is required to report hybrid rates for how these HEDIS measures, including EED, HBD, CBP, COA, COL, TRC, affect Star ratings.
Please reach out to Provider Performance Enablement or Stars Market Operations representative to discuss which method works best for your practice, and how we can collaborate to ensure you submit accurate HEDIS hybrid data for your patients.