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Quality

'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 2021 Toolkit

HEDIS®

HEDIS®

HEDIS®

Other Resources

Examples of Centers for Medicare and Medicaid Services Star measures which use statin therapy to evaluate health plans.

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: 5/20/2022
WellCare will be performing maintenance on Saturday, May 21 (from 6 PM EDT to 8 AM EDT the next day). You might not be able to access systems or fax during this time. We are sorry for any issues this may cause. Thank you for your patience. If you need assistance, contact us.
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