Quality Measures for Encounter Data (QMED)
| Date: | October 22, 2026 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan All Providers |
| Type: | Informational |
| Subject: | Quality Measures for Encounter Data (QMED) |
| Business: | Medi-Cal Managed Care |
Health Plan provided training on the updates to the Quality Measures for Encounter Data (QMED) 2.0 during a Look & Learn webinar on October 1, 2026.
The training included updated information per All Plan Letter 26.003 Quality Measures For Encounter Data Update: Quality Measures For Encounter Data 2.0 (Supersedes APL 14-020), published on 3/13/2026 located at https://www.dhcs.ca.gov/wpcontent/uploads/2026/05/APL26-003.pdf. Attachment to the APL can found at https://www.dhcs.ca.gov/wp-content/uploads/2026/04/Quality-Measures-forEncounter-Data.pdf
The webinar highlighted key changes to the way DHCS measures the quality of
encounter data based on the processed claim(s) information for the service(s) your
practice rendered.
The five Quality Measures tracked by DHCS are below:
- Uniqueness – No duplicate claims or repeated service lines, resubmit only to correct
- Completeness – Include the rendering clinician’s individual (Type 1) NPI on every claim
- Accuracy – Encounters must be corrected if denied/rejected
- Reasonability – Verify eligibility, service codes, and authorizations before you submit your claims
- Timeliness – Submit complete claims within 30 days of the date of service. Early, clean claims give everyone time to fix issues long before any deadline.
You can access the full slide deck shared during the training by visiting our website at
https://www.hpsj.com/providers/look-and-learn/ and selecting October 1, 2026 under “Past Look and Learn Information”.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
