Health Maintenance Organization (HMO) Data Reporting Requirements

Texas Health Care Information Collection
Center for Health Statistics

Who Needs to Report

Commercial Product Basic Service HMOs (PDF, 342 KB) are required to report Texas’ subset of HEDIS^® 2025 (2024 data) by service area. The requirement for reporting is based on enrollment numbers as of December 31, 2023.

What Measures to Report

THCIC expects the Texas Subset of HEDIS® 2025 (PDF, 86 KB) to be reported for the 2024 data year and HEDIS® 2025 Letter to Physicians (PDF, 108 KB) may assist you with data collection. 

When, where, and how to report:

• Commercial 
  
  THCIC has a contract with NCQA to collect and process the required Texas subset of HEDIS^® 2025 data for the state and to provide the submission guidelines.
  
  On or before June 15, HMOs must also provide copies of the completed NCQA Interactive Data Submission System (IDSS), the Audit Designation (Review) Table, and the Final Audit Statement directly to THCIC.  THCIC prefers electronic copies, which you can email to thcichelp@dshs.texas.gov.  Paper copies can be mailed to:

• Lead Data Analyst, Texas Health Care Information Collection
  DSHS - Center for Health Statistics, Mail Code -1898
  PO Box 149347
  Austin, TX 78714-9909
  Phone: 512-776-7261
  Fax: 512-776-7740
   

• Medicaid
  THCIC will not collect any data from Medicaid HMOs for HEDIS^® 2025.
• CHIP
  THCIC will not collect any data from CHIP HMOs for HEDIS^®2025.
• Medicare
  THCIC will not collect any data from Medicare HMOs for HEDIS^® 2025.

Exemption from HEDIS® Reporting

• Criteria (PDF, 264 KB) for consideration of exemption from reporting

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