Skip to main content

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. Provider participation in quality activities helps facilitate integration of Service delivery and benefit management.

Information regarding the QI Program, available upon request, includes a description of the QI Program and the evaluation of progress toward goals. WellCare evaluates the effectiveness of the QI Program on an annual basis. An annual report is summarized detailing a review of completed and continuing QI activities that address the quality of clinical care and service, trending of measures to assess performance in quality of clinical care and quality of service, any corrective actions implemented, corrective actions which are recommended or in progress, and any modifications to the program. This report is available as a written document.

2020 HEDIS Toolkit

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

HEDIS® Adult Resource Guide

KEY BEHAVIORAL MEASURES (18 Years and Older)

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

Care of Older Adult Assessment Form

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.

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

HEDIS® Guide Pediatric Quick Tips

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

KEY BEHAVIORAL MEASURES (17 Years and Older)

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?

Important Information on CPT II and HCPCS Codes

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.

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.

HEDIS® Guide Pediatric Quick Tips

HEDIS® Pediatric Resource Guide

contact-us

Need help? We're here for you.

Contact Us
Last Updated On: 11/14/2016