What BCS is
BCS stands for Breast Cancer Screening. It is the HEDIS measure, maintained by the National Committee for Quality Assurance (NCQA), that reports the percentage of women 40 to 74 years old who had at least one mammogram to screen for breast cancer within the look-back window. For MY2025, NCQA expanded the age range from 50-74 to 40-74 to align with updated U.S. Preventive Services Task Force guidance, and reports the results in two strata, 40-49 and 50-74, plus a total rate. The ECDS version of the measure is identified as BCS-E.
The window is wider than a single year. A member counts as screened if she had a mammogram any time on or between October 1 two years before the measurement year and December 31 of the measurement year, which is roughly 27 months. Digital breast tomosynthesis (3D mammography) counts; an MRI, ultrasound, or biopsy alone does not satisfy the measure.
Why BCS matters
BCS is one of the clinical quality measures that feed Medicare Star Ratings, the rating system the Centers for Medicare and Medicaid Services (CMS) applies to Medicare Advantage plans. Star Ratings drive quality bonus payments and rebate dollars, so a small movement in a screening rate has real revenue attached.
The bigger shift is reporting. NCQA has transitioned BCS to the Electronic Clinical Data Systems (ECDS) reporting standard, where the ECDS measure is identified as BCS-E. Under ECDS a gap closes only when the screening is captured as structured, sourced supplemental data, which means a mammogram performed out of network or at an imaging center the plan never sees can stay open on paper even though the member was screened.
How BCS is scored
The denominator is women 40 to 74 continuously enrolled through the measurement year. The numerator is those with a qualifying mammogram in the look-back window.
Several exclusions apply. A bilateral mastectomy, or evidence of two unilateral mastectomies, removes a member from the denominator, as does enrollment in hospice or use of hospice services. For members 66 and older, frailty combined with advanced illness, or long-term institutional residence, also excludes.
Because BCS is ECDS-reported, the practical work is sourcing the result: a supplemental data feed from the imaging provider, a health-information-exchange document, or a structured EHR value, each with the date and finding that the standard requires.
Common mistakes teams make with BCS
- Treating a claim as proof of screening. Under ECDS a paid mammography claim is not always enough; the structured result and date have to land in an accepted supplemental data source.
- Missing out-of-network mammograms. Members screen at imaging centers and retail clinics the plan never bills. Without a data feed from those sites, real screenings read as open gaps.
- Outreaching late in the year. Mammography appointments and reading turnaround take weeks, so a December push leaves no time for the result to be captured before the year closes.
- Ignoring the wide window. A mammogram from the prior year still counts. Re-contacting members who are already compliant wastes outreach capacity that recoverable gaps need.
How Pelica handles BCS
Pelica's Quality and Stars Copilot unifies BCS gaps across every payer contract on one canonical record, reconciles claims with supplemental data so a mammogram captured anywhere closes the gap, and prioritizes outreach to members who are genuinely open rather than those already screened in the look-back window. Across Pelica deployments, customers reach roughly 90% BCS completion in-year.
Related terms
BCS sits inside the HEDIS and Stars framework. See ECDS for the reporting standard BCS now uses, COL for the parallel colorectal cancer screening measure, and cut points for how a screening rate converts into a star.