Care Gaps

NaviNet care gap alerts

NaviNet provides care gap alerts in addition to eligibility and claims status information. These alerts allow you to find missing recommended services (care gaps) before a member comes in for a visit.

When you check a member's eligibility and benefits, an alert box will appear if the member has a care gap.

You can view and print your patients' Care Gap Reports, which list services your patients are missing. Place the Care Gap Report in the member's chart for services to consider during the visit.

You can also view and print a comprehensive Care Gap Report for your practice. You can choose reports based on a specific measure (e.g., preventive health screening) or all measures. To access this information, choose the Report Inquiry option from the transaction menu and then select Clinical Reports.

If you have any questions or feedback about this NaviNet feature, call First Choice VIP Care Plus Provider Services at 1-888-978-0862 or NaviNet Customer Support at 1-888-482-8057.

• NaviNet Care Gap Timing and Status Opens a new window (PDF)
• NaviNet Provider Guide: Care Gaps Response Form Opens a new window (PDF)

Gaps in care specification documents

The medical and pharmacy specification documents in the links below provide a high-level explanation of each measure's purpose. The member and provider data is used to determine whether the member has a gap in care. At the bottom of each specification document, there is a link to the companion document that details the coding criteria for each measure.

Cardiovascular

• ACE Inhibitor/ARB Therapy (HF) Opens a new window (PDF)
• Anti-Coagulant Therapy (HF) Opens a new window (PDF)
• Beta-Blocker Therapy (CAD) Opens a new window (PDF)
• Controlling High Blood Pressure Opens a new window (PDF)
• Controlling High Blood Pressure - Medication Adherence Opens a new window (PDF)

Preventive Care

• Adults' Access to Care Opens a new window (PDF)
• Anti-Rheumatic Drug Therapy Opens a new window (PDF)
• Breast Cancer Screening Opens a new window (PDF)
• Colorectal Cancer Screening Opens a new window (PDF)
• Glaucoma Screening in Older Adults (GSO) Opens a new window (PDF)
• Hepatitis B Vaccination (HBV) Opens a new window (PDF)
• Osteoporosis Management in Women Who Had a Fracture (OMW) Opens a new window (PDF)