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Quality

The Quality Improvement Program includes initiatives to ensure that members are receiving age-appropriate preventive health screenings and interventions to optimize health.

The information on this page provides useful information and tools for managing patient care based on industry-standard clinical practice guidelines.

Preventive Depression Screening Program

This program promotes collaboration, continuity and coordination between medical and behavioral health care.

2019 HEDIS Toolkit

HEDIS® (Healthcare Effectiveness Data and Information Set)

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

This form is to assess care needs for older adults.

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

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.

Medication Reconciliation Post-Discharge (MRP): This HEDIS measure ensures that members who are discharged from the hospital have their medications reviewed by a prescribing practitioner, clinical pharmacist or registered nurse within 30 days of discharge. An outpatient visit is not required, but is highly encouraged.

This guide alerts you to important preventive care and services that you can provide to patients to help boost Star Ratings.

2018 HEDIS Toolkit

HEDIS® ensures health plans are offering quality preventive care and service to members. It also allows for a true comparison of the performance of health plans by consumers and employers.

2018 HEDIS At-a-Glance Key Adult Measures

This document details the importance of coordination of care.

HEDIS Guide Adult Quick Tips

Important information for Medicare providers.

2018 HEDIS At-a-Glance Key Behavioral Measures (17 Years and Younger)

At WellCare, we value everything you do to deliver quality care for our members – your patients – to make sure they have a positive health care experience. That’s why we’ve created this easy-to-use, informative HEDIS® At-A-Glance Guide. It gives you the tools you need to meet, document and code HEDIS Measures.

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

This form is to assess care needs for older adults.

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

The survey is used to measure how the care provided by Medicare Advantage Organizations (MAO) affects the health outcomes of their enrollees.

Medication Reconciliation Post-Discharge (MRP): This HEDIS measure ensures that members who are discharged from the hospital have their medications reviewed by a prescribing practitioner, clinical pharmacist or registered nurse within 30 days of discharge. An outpatient visit is not required, but is highly encouraged.

2018 HEDIS At-a-Glance Key Pediatric Measures

HEDIS Guide Pediatric Quick Tips

HEDIS reference guide for Pediatric care.

This guide alerts you to important preventive care and services that you can provide to patients to help boost Star Ratings.

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Last Updated On: 8/6/2018
Beginning January 1, 2019, Harmony Health Plan will become part of Meridian Health Plan of Illinois. Read More. ×