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Quality

Overview

‘Ohana Health Plan’s Quality Improvement (QI) Program monitors and evaluates the quality, appropriateness, accessibility and availability of health care services.

Medical Records

QI may conduct annual medical record audits in physician offices. Patient records are reviewed for evidence that care and screenings have been documented. Complete information is available in the Medicaid  or Medicare Advantage provider manuals.

Clinical Practice Guidelines

CPGs outline medical standards of care and best practices.

HEDIS®*

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

2017 HEDIS Toolkits

HEDIS ensures health plans are offering quality preventive care and service to members.

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

Information to help you submit consistent, detailed claims to help reduce medical.

Important information for Medicare providers.

HEDIS reference guide for Pediatric care.

A HEDIS quick reference guide for Pediatric care

2017 HEDIS At-a-Glance Key Adult Measures

2017 HEDIS At-a-Glance Key Pediatric Measures

2017 HEDIS At-a-Glance Key Behavioral Measures (17 Years and Younger)

2017 HEDIS At-a-Glance Key Behavioral Health Measures (18 Years and Older)

Preventive Health Counseling and Education for Children and Adolescents (Ages 3-17 Years)

This document details the importance of coordination of care.

How to Code for a Well Visit with a Sick Visit

Other Resources

These questions below were developed to determine whether a tuberculin skin test is indicated.

Helpful Information

EPSDT Program

Sign in to our secure Provider Portal to find out which eligible members are due for EPSDT screenings. If you haven’t registered on our site, please join today. Preventive pediatric health care guidelines for children are located in our clinical practice guidelines.

Provider Participation

Network providers are contractually required to cooperate with quality improvement activities. Providers are also invited to volunteer for the QI Program. Please contact us if you’re interested in volunteering.
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Last Updated On: 12/23/2016