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Quality

The Quality Improvement (QI) Program monitors and evaluates the quality, appropriateness, accessibility and availability of health care services.

HEDIS®

HEDIS® is a tool used by more than 90% of America’s health plans to measure performance on important dimensions of care and service. The tool is comprised of 80 measures across five domains of care, including:

  • Effectiveness of care
  • Access and availability of care
  • Experience of care
  • Utilization and Relative Resource Use
  • Health Plan Descriptive Information

HEDIS® is a mandatory process that occurs annually. We've developed this toolkit to help identify required preventive services.


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

An Advance Directive is a mandatory self-determination act which is required by the state of New Jersey.

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?

HEDIS 2019

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.

You’ve Inspired Us, Now We Reward You

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

Pediatric and Behavioral Health 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

Please maintain in the patient file. This tool is designed to be a working record for all WellCare members.

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.

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.

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.

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

2018 HEDIS At-a-Glance Key Pediatric Measures

HEDIS Guide Pediatric Quick Tips

HEDIS reference guide for Pediatric care.

How to Code for a Well Visit with a Sick Visit

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

Helpful Information

View Clinical Guidelines

Clinical Coverage Guidelines
Evidence-based guidelines detailing the medical necessity of procedures or technologies.

Clinical Practice Guidelines
CPGs outline medical standards of care and best practices.

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. 

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.
  • Clinical Guidelines

    View Clinical Guidelines

    Clinical Coverage Guidelines
    Evidence-based guidelines detailing the medical necessity of procedures or technologies.

    Clinical Practice Guidelines
    CPGs outline medical standards of care and best practices.

  • Medical Records

    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. 

  • Provider Participation

    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: 8/6/2018