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Quality

The Quality Improvement Program includes initiatives to ensure that members are receiving age-appropriate preventive health screenings and interventions to optimize health.

The information on this page provides useful information and tools for managing patient care based on industry-standard clinical practice guidelines.

Preventive Depression Screening Program

This program promotes collaboration, continuity and coordination between medical and behavioral health care.

2019 HEDIS Toolkit

HEDIS® Guide Adult Quick Tips

This form is to assess care needs for older adults.

Every year CMS or NCQA may ask your patient the following questions. How do you rate?

The survey is used to measure how the care provided by Medicare Advantage Organizations (MAO) affects the health outcomes of their enrollees.

We’re asking our providers to make sure to use accurate CPT Category II codes to improve efficiencies in closing patient care gaps and in data collection for performance measurement.

This guide alerts you to important preventive care and services that you can provide to patients to help boost Star Ratings.

2018 HEDIS Toolkit

HEDIS® ensures health plans are offering quality preventive care and service to members. It also allows for a true comparison of the performance of health plans by consumers and employers.

2018 HEDIS At-A-Glance Key Adult Measures

This document details the importance of coordination of care.

HEDIS Guide Adult Quick Tips

Important information for Medicare providers.

At WellCare, we value everything you do to deliver quality care for our members – your patients – to make sure they have a positive health care experience. That’s why we’ve created this easy-to-use, informative HEDIS® At-A-Glance Guide. It gives you the tools you need to meet, document and code HEDIS Measures.

At WellCare, we value everything you do to deliver quality care for our members – your patients – to make sure they have a positive health care experience. That’s why we’ve created this easy-to-use, informative HEDIS® At-A-Glance Guide. It gives you the tools you need to meet, document and code HEDIS Measures.

Information concerning the mental and emotional well-being of patients.

This form is to assess care needs for older adults.

Every year CMS or NCQA may ask your patient the following questions. How do you rate?

The survey is used to measure how the care provided by Medicare Advantage Organizations (MAO) affects the health outcomes of their enrollees.

Medication Reconciliation Post-Discharge (MRP): This HEDIS measure ensures that members who are discharged from the hospital have their medications reviewed by a prescribing practitioner, clinical pharmacist or registered nurse within 30 days of discharge. An outpatient visit is not required, but is highly encouraged.

2018 HEDIS At-a-Glance Key Pediatric Measures

2018 HEDIS Guide Pediatric Quick Tips

HEDIS reference guide for Pediatric care.

This guide alerts you to important preventive care and services that you can provide to patients to help boost Star Ratings.

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Last Updated On: 8/6/2018
Based on a recent legal decision, changes to Medicaid under Kentucky HEALTH will not begin on July 1, 2018 as planned. Read more. Important Update about Kentucky HEALTH ×