Gaps In Care Specification Documents
The medical and pharmacy specification documents in the links below provide a high-level explanation of each measure's purpose. The member and provider data is used to determine whether the member has a gap in care. At the bottom of each specification, there is a link to the companion document that details the coding criteria for each measure.
Asthma
- Asthma Controller Therapy (PDF)
- Asthma Medication Adherence (PDF)
- Asthma Medication Management (PDF)
- STA - Inhaled Corticosteroid (PDF)
Cardiovascular
- ACEI/ARB Therapy (CAD) (PDF)
- ACEI/ARB Therapy (HF) (PDF)
- ACS ACE-ARB Therapy (PDF)
- ACS Aspirin Therapy (PDF)
- ACS Beta Blocker Therapy (PDF)
- ACS Plavix Therapy (PDF)
- ACS Statin Therapy (PDF)
- Anti-Coagulant Therapy (HF) (PDF)
- Antiplatelet Therapy (CAD) (PDF)
- Beta-Blocker Therapy (CAD) (PDF)
- Beta Blocker Therapy (HF) (PDF)
- Controlling High Blood Pressure (PDF)
- Controlling High Blood Pressure - Medication Adherence (PDF)
- Dyslipidemia Lipid Therapy (PDF)
- Event Cholesterol Test (CAD) (PDF)
- Lipid Test (CMC) - for Coronary Artery Disease (CAD) (PDF)
- LVF Assessment (HF) (PDF)
- STA - Renin Inhibitors (PDF)
- STA - Statins (PDF)
Diabetes
- Diabetes Eye Exam (PDF)
- Diabetes HbA1c Test (PDF)
- Diabetes Macroalbumin Test (PDF)
- Lipid Test (CDC) - for Diabetes (PDF)
- Diabetes ACE-ARB Therapy (PDF)
- Diabetes Screening for People w/Diagnosis or Medication that Requires Diabetes Screening (PDF)
- Diabetes Testing (PDF)
- STA - Oral Diabetes Medicines (PDF)
Preventive Care
- Adolescent Well Care (PDF)
- Adult Access to Care (PDF)
- Annual Dental Visit (PDF)
- Anti-Rheumatic Drug Therapy (PDF)
- Breast Cancer Screening (PDF)
- Cervical Cancer Screening (PDF)
- Chicken Pox Vaccination (PDF)
- Colorectal Cancer Screening (PDF)
- Diphtheria, Tetanus, and Pertussis Vaccination (DTaP) (PDF)
- EPSDT - Developmental Screening (PDF)
- EPSDT - Hearing (PDF)
- EPSDT - Vision (PDF)
- Glaucoma Screening in Older Adults (GSO) (PDF)
- Haemophilus Influenzae Type B Vaccination (HiB) (PDF)
- Hepatitis A Vaccination (PDF)
- Hepatitis B Vaccination (HBV) (PDF)
- Hepatitis C SVR-12 (SVR) (PDF)
- Lead Screening in Children (LSC) (PDF)
- Measles, Mumps, and Rubella Vaccination (MMR) (PDF)
- Osteoporosis Management in Women Who Had a Fracture (OMW) (PDF)
- Pneumococcal Vaccination (PDF)
- Primary Care Visit 1 to 2 Years (12 months to 24 months of age) (PDF)
- Primary Care Visit 2 to 6 Years (25 months to 6 years of age) (PDF)
- Primary Care Visit 7 to 11 Years (PDF)
- Well Child Visit 18 Months and Younger (PDF)
Sickle Cell Disease