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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.

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

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Last Updated On: 11/14/2016