PDO: Use of Opioids From Multiple Providers
Percentage with opioids from 4+ prescribers, OR 4+ pharmacies, OR cumulative MME ≥90 in 90 days.
Measure description
Percentage with opioids from 4+ prescribers, OR 4+ pharmacies, OR cumulative MME ≥90 in 90 days.
Eligible population
Members with chronic opioid use
Performance drivers
Star measure + CMS opioid safety.
Documentation & PA strategy
Single-prescriber clause + PDMP check + MME cap. Document if exception needed.
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 PDO measure?
Percentage with opioids from 4+ prescribers, OR 4+ pharmacies, OR cumulative MME ≥90 in 90 days.
What drives performance on this measure?
Star measure + CMS opioid safety.
How should clinicians document for this measure?
Single-prescriber clause + PDMP check + MME cap. Document if exception needed.
What is the eligible population?
Members with chronic opioid use
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