PCC: Prenatal Care Access — First Trimester
First prenatal visit within first trimester (≤13 weeks) or within 42 days of enrollment.
Measure description
First prenatal visit within first trimester (≤13 weeks) or within 42 days of enrollment.
Eligible population
Pregnant members
Performance drivers
Maternal health quality.
Documentation & PA strategy
Early pregnancy referral; OB scheduling.
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 PCC measure?
First prenatal visit within first trimester (≤13 weeks) or within 42 days of enrollment.
What drives performance on this measure?
Maternal health quality.
How should clinicians document for this measure?
Early pregnancy referral; OB scheduling.
What is the eligible population?
Pregnant members
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