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LOINC® Codes and HEDIS

Date: 03/25/25

What is LOINC®? Logical Observation Identifiers Names and Codes (LOINC®) is a common language (set of identifiers, names, and codes) for identifying health measurements, observations, and documents. [1] LOINC® was developed to provide a definitive standard for identifying clinical information in electronic reports.

LOINC® is considered a universal coding system, enabling health care organizations to map (or link) their local codes to LOINC® codes for transmission in clinical messages to payers, regulators, and other health care organizations[2].  These codes can describe in detail what test or screening was performed.

NCQA added measures requiring LOINC® to the HEDIS® Electronic Clinical Data Systems (ECDS) reporting to encourage health information exchange, which is the secure sharing of patient medical information electronically. [3] ECDS reporting is part of NCQA’s larger strategy to enable a Digital Quality System and is aligned with the industry’s move to digital measures.

What HEDIS® measures use LOINC® codes? The below measures require a LOINC® code submission to capture compliance for the screening numerator:

  • Depression Remission or Response for Adolescents and Adults (DRR-E)
  • Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)
  • Prenatal Depression Screening and Follow-Up (PND-E)
  • Postpartum Depression Screening and Follow-Up (PDS-E)
  • Social Need Screening and Intervention (SNS-E)
  •  Unhealthy Alcohol Use Screening and Follow-Up (ASF-E)
  • Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E)

How are LOINC® codes shared with Centene? LOINC® requires electronic submission and cannot be added to medical claim. Centene uses a supplemental data process to capture LOINC® codes- files are transmitted directly from EHR systems and through flat files submissions. Ask your Provider Engagement or Quality Improvement representative for more information.

This document is an informational resource designed to assist licensed healthcare practitioners in caring for their patients. Healthcare practitioners should use their professional judgment in using the information provided.

If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call us at the number below:

Sources:

[1] https://loinc.org/

[2] https://digital.ahrq.gov/loinc

[3] https://www.healthit.gov/topic/health-it-and-health-information-exchange-basics/health-information-exchange