PPC: Prenatal and Postpartum Care
Rate 1: timely prenatal care (1st trimester or within 42 days of enrollment). Rate 2: postpartum visit 7-84 days post-delivery.
Measure description
Rate 1: timely prenatal care (1st trimester or within 42 days of enrollment). Rate 2: postpartum visit 7-84 days post-delivery.
Eligible population
Members who had live birth
Performance drivers
Star measure.
Documentation & PA strategy
Schedule 6-week postpartum visit + bundle into delivery plan.
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 PPC measure?
Rate 1: timely prenatal care (1st trimester or within 42 days of enrollment). Rate 2: postpartum visit 7-84 days post-delivery.
What drives performance on this measure?
Star measure.
How should clinicians document for this measure?
Schedule 6-week postpartum visit + bundle into delivery plan.
What is the eligible population?
Members who had live birth
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