Guide · Reviewed 2026-11-01
HEDIS (Healthcare Effectiveness Data and Information Set) is NCQA's set of more than 90 performance measures across six domains of care. Health plans report it, and more than 235 million people are enrolled in plans that do. Arkangel AI helps quality teams review charts against configured HEDIS criteria and flags possible gaps for clinical validation.
NCQA groups HEDIS measures into six domains of care:
| Domain | What it covers |
|---|---|
| Effectiveness of Care | Whether members receive recommended preventive and chronic care. |
| Access/Availability of Care | Whether members can get care when they need it. |
| Experience of Care | How members rate their care and their plan (CAHPS surveys). |
| Utilization and Risk Adjusted Utilization | How services are used, including risk-adjusted comparisons. |
| Health Plan Descriptive Information | Information that describes the plan and its members. |
| Measures Reported Using Electronic Clinical Data Systems | Measures reported from electronic clinical data (ECDS). |
The descriptions in the second column are our plain-language summaries; the domain names are NCQA's. Measure specifications are published by NCQA in the HEDIS Technical Specifications.
Source: NCQA, “HEDIS MY 2026: What's New, What's Changed, What's Retired” (August 1, 2025) and NCQA's hybrid-measure timeline. NCQA has also published MY 2027 updates; check the current specifications before you build reports.
NCQA's Health Plan Ratings score commercial, Medicare and Medicaid plans on HEDIS, CAHPS patient-experience and HOS measures, plus accreditation status. CMS Medicare Part C Star Ratings also use some HEDIS measures, with a different methodology.
Because the hybrid method is being phased out, more measures depend on structured electronic clinical data. Documentation that is complete and coded at the point of care matters more each year.
Select the HEDIS criteria your team tracks, with the current NCQA specifications and your own exclusions.
Arkangel AI reads the records you make available and flags possible care and documentation gaps, citing the chart text behind each one.
Your quality and clinical staff accept or dismiss each finding. Nothing is reported without human review.
Use validated findings to plan outreach, provider education or documentation fixes. Results depend on your data; scores are not guaranteed.
HEDIS measures are standardized performance measures maintained by the National Committee for Quality Assurance (NCQA). There are more than 90, grouped into six domains such as Effectiveness of Care and Access/Availability of Care. Health plans report them so purchasers and members can compare quality across plans on the same definitions.
NCQA collects HEDIS data from health plans and other health care organizations, and results are audited to protect their validity. More than 235 million people are enrolled in plans that report HEDIS results, according to NCQA. Providers contribute through the claims, encounter and clinical data their documentation produces.
For measurement year 2026, NCQA added seven measures, retired two, including Asthma Medication Ratio, and moved four into ECDS reporting. Lead Screening in Children and the two statin therapy measures became ECDS-only. The specifications also adopted a format aligned with the FHIR standard, without changing measure intent.
The hybrid method combines administrative data with a sample of medical record reviews to calculate certain measures. NCQA plans to phase it out by measurement year 2029 as reporting moves to electronic clinical data systems (ECDS), so structured, complete documentation in the record matters more each year.
AI can review the records a plan or provider makes available against configured HEDIS criteria and flag possible care and documentation gaps, citing the chart text behind each one. Arkangel AI keeps every finding for clinical validation by your team. It does not submit data to NCQA or guarantee rates.
Book a 30-minute consultation. We walk through how Arkangel AI reviews a sample of supported records against the criteria you configure, with every finding cited and validated by your team.
Last reviewed: . HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). This guide summarizes public NCQA information and is not affiliated with or endorsed by NCQA. Check the current HEDIS specifications before reporting. Arkangel AI findings require clinical validation; quality scores are not guaranteed.