Quality360®: One Unified HEDIS® Platform
Quality360 unifies Healthcare Effectiveness Data and Information Set (HEDIS®) abstraction, chase management, and analytics into a single National Committee for Quality Assurance (NCQA)-certified workflow. Health plans get one source of truth for quality performance, retrieval rates above 95%, and zero audit issues on retrospective submissions.
See Quality360 in Action
One Connected Workflow, Real Time from End-to-End
HEDIS abstraction, chase management, and reporting run inside a single NCQA-certified platform. Built-in lineage tracking and real-time validation mean quality teams see gaps and progress as they happen instead of piecing results together after the season ends. Natural language processing (NLP) powers continual gap closure across both prospective and regulatory abstraction.
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Real-time hybrid reporting and scorecards with no data lag
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Built-in lineage tracking and real-time validation supporting audit confidence
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77%+ year-over-year hybrid measure rate improvement and 28% Stars improvement (MY2024)
Certified Abstractors Focused on Complex Chart Review
Automation without human oversight creates compliance exposure. Move too fast without judgment built in, and errors reach submission unchecked. Configurable chase rules and automated data hygiene handle the routine work, freeing certified abstractors to apply their judgment to the charts that actually need it. That balance reflects how HealthEdge deploys AI across the board: automation handles volume, and the industry's deepest concentration of payer and quality expertise handles judgment.
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Intelligent, configurable chase management drives higher retrieval
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Automated data hygiene catches anomalies before submission
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100% medical record review validation pass rate
What's Inside Quality360?
HEDIS Abstraction Tool: Scalable Chart Review
Certified abstractors work inside a scalable platform that prioritizes charts intelligently and integrates with any quality engine, supporting standalone or integrated deployment across internal and vendor-driven operations. Real-time compliance validation is built into every chart review, and dynamic, configurable abstraction forms support rapid measure rollout. Throughput and accuracy improve without locking teams into a single vendor's abstraction workflow.
Chase Management: Unified Gap Closure
Intelligent, configurable chase rules drive retrieval automatically and increase retrieval success rates. A self-service user interface (UI) lets health plans adjust measure logic and sampling without waiting on engineering support, unifying prospective and retrospective chase into a single workflow that cuts manual chase effort by 40%.
Reporting: Performance in Real Time
Executive dashboards track measure rates and progress in real time, while provider-level insights identify where targeted intervention will move the needle. Predictive and comparative analytics benchmark performance against industry standards, turning quality data into a real-time operating signal that replaces static, after-the-fact reporting with visibility teams can act on mid-season.
Full Season Audit Support: Start to Finish
Audit readiness is a supported process that runs from the first Primary Source Verification (PSV) through final submission, spanning PSV, roadmap completion, and onsite or virtual audit assistance, along with Interactive Data Submission System (IDSS) and Patient-Level Data (PLD) testing and submission support. Proactive data and issue-log support continue throughout the audit season.
Retrieval and Accuracy at Scale
A single source of truth for quality metrics, backed by certified abstraction and automated chase management, turns retrieval and Stars performance into predictable outcomes rather than seasonal scrambles.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)