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Medicaid Providers

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Quality

WellCare of Nebraska wants to ensure quality, cost-effective health care solutions for our members. Our Quality Improvement (QI) Program aims to advance patient safety and care so our members can stay healthy and manage chronic health problems.

Provider Participation

Network Providers are contractually required to cooperate with quality improvement activities. Providers are invited to volunteer for participation in the QI Program. Avenues for participation include committee representation, quality/performance improvement projects, Early and Periodic Screening, Diagnosis and Treatment (EPSDT) assessments and feedback/input via satisfaction surveys, grievances and calls to Customer Service.

Learn more about provider participation.

2020 HEDIS Toolkit

HEDIS® Guide Adult Quick Tips

2019 HEDIS® AT-A-GLANCE: KEY ADULT MEASURES

HEDIS® Adult Resource Guide

Coordination of Care requires proactively identifying the patient’s needs, organizing care and communicating vital information at the right time to the right people.

KEY BEHAVIORAL MEASURES (18 Years and Older)

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

Care of Older Adult Assessment Form

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.

2020 HEDIS® AT-A-GLANCE: KEY PEDIATRIC MEASURES

HEDIS® Guide Pediatric Quick Tips

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

KEY BEHAVIORAL MEASURES (17 Years and Older)

Pediatric and Behavioral Health Measures

2019 HEDIS Toolkit

HEDIS® (Healthcare Effectiveness Data and Information Set)

2019 HEDIS® AT-A-GLANCE: KEY ADULT MEASURES

HEDIS® Guide Adult Quick Tips

HEDIS® Adult Resource Guide

KEY BEHAVIORAL MEASURES (17 Years and Older)

KEY BEHAVIORAL MEASURES (18 Years and Older)

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

Important Information on CPT II and HCPCS Codes

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.

2019 HEDIS® AT-A-GLANCE: KEY PEDIATRIC MEASURES

What are your patients saying about the care they received? Each year, a child CAHPS survey is conducted to collect information about patient healthcare experience. Studies show patients who are happy with their personal doctor are more compliant to treatment plans and have better health outcomes.

HEDIS® Guide Pediatric Quick Tips

HEDIS® Pediatric Resource Guide

Program Overview

Case Management

Secure Provider Portal

This program coordinates individualized, cost-effective and integrated services to foster positive clinical outcomes for our medically compromised population. Goals include:

  • Decrease fragmentation of health care service delivery
  • Facilitate appropriate use of available resources
  • Optimize member outcomes through education, care coordination and advocacy services

Disease Management

This program provides education and health coaching to empower our members to manage chronic conditions, including asthma, diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), coronary artery disease (CAD), hypertension, depression and human immunodeficiency virus (HIV).

EPSDT Program

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program
Improves the rate of members receiving health assessment screenings and testing.

  • Case Management

    Case Management

    Secure Provider Portal

    This program coordinates individualized, cost-effective and integrated services to foster positive clinical outcomes for our medically compromised population. Goals include:

    • Decrease fragmentation of health care service delivery
    • Facilitate appropriate use of available resources
    • Optimize member outcomes through education, care coordination and advocacy services
  • Disease Management

    Disease Management

    This program provides education and health coaching to empower our members to manage chronic conditions, including asthma, diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), coronary artery disease (CAD), hypertension, depression and human immunodeficiency virus (HIV).

  • EPSDT Program

    EPSDT Program

    Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program
    Improves the rate of members receiving health assessment screenings and testing.

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Last Updated On: 12/13/2020