KCA: Kidney Health Evaluation for Patients With Diabetes
Percentage with both eGFR AND uACR (urine albumin/creatinine) during measurement year.
Measure description
Percentage with both eGFR AND uACR (urine albumin/creatinine) during measurement year.
Eligible population
Members with DM
Performance drivers
Combined screening replaces older nephropathy screening alone.
Documentation & PA strategy
Order both eGFR (basic metabolic panel) and uACR (random urine).
Why HEDIS matters for prior authorization
Health plans align prior authorization criteria with HEDIS measures: documenting your patient meets the HEDIS definition often streamlines or eliminates PA hurdles. For Medicare Advantage in particular, plans are heavily incentivized via Star Ratings to push members and providers toward measure compliance, which translates into faster approvals for measure-aligned services.
Frequently asked questions
What does HEDIS measure KCA measure?
Percentage with both eGFR AND uACR (urine albumin/creatinine) during measurement year.
What drives performance on this measure?
Combined screening replaces older nephropathy screening alone.
How should clinicians document for this measure?
Order both eGFR (basic metabolic panel) and uACR (random urine).
What is the eligible population?
Members with DM
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