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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.


New: HEDIS Measurement Year 2020 Toolkit

HEDIS®

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 Pocket Guide

When billing for an Evaluation and Management (E/M) service in addition to a preventive service, remember these guidelines from the Preventive Medicine Services section in the CPT book

HEDIS®

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

HEDIS®

HEDIS®

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

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: 12/13/2020