HEDIS Care Gaps

Participating primary care providers can access and resolve Healthcare Effectiveness Data and Information Set (HEDIS) care gaps for AmeriHealth Caritas Florida members via NaviNet.

Care gaps identify missing recommended preventive care services so that you may address them when your patient comes in for an office visit. Care gaps are based on HEDIS measures and may impact your quality scores. Some examples might be, Adult Access to Care, a well- child visit, or scheduling a mammogram.

Once you've logged in to NaviNet, check the Activity tab to see alerts for care gaps that need your response. Alternatively, you can click on Patient Clinical Documents under Workflows to see the list of members who have care gaps. You will also see care gaps for your patients upon using the Eligibility and Benefits Inquiry, and on the Member Clinical Summary and Care Gap Query Report.

Read our Care Gap Response Form Provider Guide (PDF) for more information.

Care gap resources

Care Gap Response Form Provider Guide (PDF)

Complete User Attestation to Access Care Gaps in NaviNet (PDF)

NaviNet Care Gap Response Form Documentation List (PDF)