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Quality

WellCare of North Carolina wants to ensure that our members have access to quality, cost-effective health care solutions. Our Quality Improvement (QI) program aims to improve patient safety and care so our members can enhance their quality of life by staying healthy or managing their chronic health problems.

HEDIS®

HEDIS® is a mandatory process that occurs annually. We've developed a toolkit to help identify required preventive services.

To identify and close gaps in members’ health care, log in to the provider portal and access HEDIS Online Tools. If you don’t have an account, you can register online.

2020 HEDIS Toolkit

This easy-to-use HEDIS® At-A-Glance Guide gives you the tools to meet, document and code HEDIS Measures.

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

HEDIS® Guide Adult Quick Tips

HEDIS® Adult Resource Guide

2019 HEDIS® AT-A-GLANCE: KEY BEHAVIORAL MEASURES (17 Years and Younger)

2019 HEDIS® AT-A-GLANCE: KEY BEHAVIORAL MEASURES (18 Years and Older)

Consumer Assessment of Healthcare Providers and Systems/Child CAHPS® Provider Quick Reference Guide

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

Important Information on CPT II and HCPCS Codes

KEY PEDIATRIC MEASURES

HEDIS® Guide Pediatric Quick Tips

HEDIS® Pediatric and Behavioral Health Measures

Preventive Health Counseling and Education for Children and Adolescents Ages 3–17 Years

Pediatric Well-Visit Sick-Visit Form

This guide alerts you to important women's preventive care and services.

2019 HEDIS Toolkit

HEDIS® (Healthcare Effectiveness Data and Information Set)

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

HEDIS® Adult Resource Guide

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

Important Information on CPT II and HCPCS Codes

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.

Pediatric and Behavioral Health 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.

Preventive Health Counseling and Education for Children and Adolescents Ages 3–17 Years

Additional Information

Medical Records Audits

Quality Improvement (QI) may conduct annual medical record audits in physician offices. Patient records are reviewed for evidence that care and screenings have been documented. 


Quality Improvement Participation

Network providers are contractually required to cooperate with quality improvement activities. Providers are also invited to volunteer for the Quality Improvement (QI) Program. Please contact us if you’re interested in volunteering.

  • Medical Records

    Medical Records Audits

    Quality Improvement (QI) may conduct annual medical record audits in physician offices. Patient records are reviewed for evidence that care and screenings have been documented. 


  • Provider Participation

    Quality Improvement Participation

    Network providers are contractually required to cooperate with quality improvement activities. Providers are also invited to volunteer for the Quality Improvement (QI) Program. Please contact us if you’re interested in volunteering.

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Last Updated On: 12/20/2019