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Quality

WellCare of Nebraska wants to ensure quality, cost-effective health care solutions for our members. Our Quality Improvement (QI) Program aims to advance patient safety and care so our members can stay healthy and manage chronic health problems.

Provider Participation

Network Providers are contractually required to cooperate with quality improvement activities. Providers are invited to volunteer for participation in the QI Program. Avenues for participation include committee representation, quality/performance improvement projects, Early and Periodic Screening, Diagnosis and Treatment (EPSDT) assessments and feedback/input via satisfaction surveys, grievances and calls to Customer Service.

Learn more about provider participation.

2019 HEDIS Toolkit

HEDIS® (Healthcare Effectiveness Data and Information Set)

2019 HEDIS® AT-A-GLANCE: KEY ADULT MEASURES

HEDIS® Guide Adult Quick Tips

HEDIS® Adult Resource Guide

KEY BEHAVIORAL MEASURES (17 Years and Older)

KEY BEHAVIORAL MEASURES (18 Years and Older)

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

2019 HEDIS® AT-A-GLANCE: KEY PEDIATRIC 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

HEDIS® Guide Pediatric Quick Tips

HEDIS® Pediatric Resource Guide

2018 HEDIS Toolkit

2018 HEDIS At-a-Glance Key Adult Measures

This document details the importance of coordination of care.

HEDIS Guide Adult Quick Tips

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

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.

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

How to Code for a Well Visit with a Sick Visit

HEDIS Guide Pediatric Quick Tips

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

2018 HEDIS At-a-Glance Key Pediatric Measures

Program Overview

Case Management

Secure Provider Portal

This program coordinates individualized, cost-effective and integrated services to foster positive clinical outcomes for our medically compromised population. Goals include:

  • Decrease fragmentation of health care service delivery
  • Facilitate appropriate use of available resources
  • Optimize member outcomes through education, care coordination and advocacy services

Disease Management

This program provides education and health coaching to empower our members to manage chronic conditions, including asthma, diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), coronary artery disease (CAD), hypertension, depression and human immunodeficiency virus (HIV).

EPSDT Program

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program
Improves the rate of members receiving health assessment screenings and testing.

  • Case Management

    Case Management

    Secure Provider Portal

    This program coordinates individualized, cost-effective and integrated services to foster positive clinical outcomes for our medically compromised population. Goals include:

    • Decrease fragmentation of health care service delivery
    • Facilitate appropriate use of available resources
    • Optimize member outcomes through education, care coordination and advocacy services
  • Disease Management

    Disease Management

    This program provides education and health coaching to empower our members to manage chronic conditions, including asthma, diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), coronary artery disease (CAD), hypertension, depression and human immunodeficiency virus (HIV).

  • EPSDT Program

    EPSDT Program

    Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program
    Improves the rate of members receiving health assessment screenings and testing.

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Last Updated On: 10/9/2017