Everyone wants the best health outcomes for their members. As a provider, you are in a unique position to help through well-care visits. Parents don't realize how critical well-care visits are to keeping a child's health and development on track.

The National Committee on Quality Assurance (NCQA) assesses health plans and providers annually to ensure that critical quality measures, including well-care visits, are being encouraged, performed, and properly documented.

NCQA VISIT REQUIREMENTS

NCQA measures well-care visits across three age-based categories:

1. Well-Child Visits in the First 15 Months of Life: At least 6 well-child visits by 15 months.

2. Well-Child Visits for Age 15 Months–30 Months: At least 2 well-child visits between 15 and 30 months.

   Important Opportunity: Performance data consistently shows that children are much less likely to complete the required 2 visits between 15–30 months. This is a key gap impacting compliance rates.

3. Child and Adolescent Well-Care Visits (WCV): Measures annual well-care visits for children and adolescents ages 3–21 years.
   Requirement: 1 well-care visit between January 1 and December 31 of the measurement year.

HEDIS 2025 quality performance scores for our network indicate significant opportunities to improve well-care visit compliance rates. For some of our benefit plans, less than half of eligible members are receiving recommended visits.

Our members and all your patients need your help to achieve better health outcomes.

HOW CAN PROVIDERS HELP MEMBERS AND, CONSEQUENTLY, IMPROVE THE OUTCOME AND RATES FOR WELL-CARE VISIT MEASURES?

As their trusted provider, your voice is critical in explaining why well visits are important for protecting each child and achieving better outcomes.

Use this checklist to improve performance and ensure visit compliance:

SCHEDULING & TEMPLATES

• Build 2 visits between 15–30 months into standard well-child scheduling templates.
• Pre-schedule the 18-month and 24-month visits before the patient leaves the office.
• Confirm visit intervals align with NCQA age requirements.

PATIENT OUTREACH

• Use reminder systems (calls, texts, portal) to prompt families for upcoming visits.
• Target outreach to children approaching 15 months and 24 months.
• Follow up on missed or canceled appointments promptly.

COMPLIANCE TIMING

• Verify patient age at time of visit — must occur before 30-month birthday.
• Avoid scheduling visits too close to the 30-month cutoff.
• Monitor patients nearing age limits and expedite scheduling when needed.

CARE TEAM ENGAGEMENT

• Educate front desk and care teams on 15–30 months requirements.
• Reinforce the importance of completing both visits, not just one.
• Use care gap reports to identify and prioritize overdue patients.

DOCUMENTATION

• Ensure visits are coded and documented as well-child visits.
• Capture all required elements to support compliance and bill correct well-visit codes.

Regular appointments allow providers, parents, and children to take a team approach to health.

Thank you for your continued commitment to excellence in patient care.