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Quality

WellCare of New York 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.

CAHPS: An Important Message to our Valued Providers
Your patients, our members, will be receiving the New York State, Medicaid CAHPS surveys very soon. Are you and your office staff doing what it takes to ensure your patients are satisfied with their health care services? Do you know what your patients have already been saying? To stay up-to-date and informed on the latest, please take a moment to review some important information.

Million Hearts Action Guide
The Hypertension Control: Change Package for Clinicians  is a quality improvement tool for ambulatory clinical settings to improve hypertension control. This guide includes change concepts, change ideas, and evidence or practice based tools and resources.

Resources

HEDIS ensures health plans are offering quality preventive care and service to members.

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

Information to help you submit consistent, detailed claims to help reduce medical.

Important information for Medicare providers.

HEDIS reference guide for Pediatric care.

A HEDIS quick reference guide for Pediatric care

This document details the importance of coordination of care.

2017 HEDIS At-a-Glance Key Adult Measures

2017 HEDIS At-a-Glance Key Pediatric Measures

2017 HEDIS At-a-Glance Key Behavioral Measures (17 Years and Younger)

2017 HEDIS At-a-Glance Key Behavioral Health Measures (18 Years and Older)

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

How to Code for a Well Visit with a Sick Visit

Other Resources

WellCare shall monitor providers against the following standards to ensure members can obtain needed health services within the acceptable appointment time frames, in-office waiting times, and after-hours standards.

New York Confidential Case Report Form

Promoting cultural and linguistic competency self-assessment checklist for personnel providing primary health care services

A form used to order copies of the New York State Health Care Proxy

The documentation standards listed here applies to all medical records

The documentation listed here applies to all obstetrical records

QARR Quick Reference Guide for New York State

The purpose of this letter is to inform you about recently adopted amendments to regulations at 10 NYCRR Subpart 66-1 addressing school immunization requirements.

This tool is designed to be a working record for all WellCare members.

Helpful Information

Case Management

Provide coordination of individualized, timely, cost-effective and integrated services to promote positive clinical outcomes for members. The purpose of WellCare’s Case Management program for our medically compromised population is:

  • 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

Provide 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).

EPSTD Program

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

Health and Wellness

Helps members stay healthy by providing access to educational materials and health tips.

Vaccines for Children Program

The New York Vaccines for Children program ensures children receive their vaccines in accordance with Advisory Committee on Immunization Practices (ACIP) guidelines and periodicity schedule.

  • Case Management

    Case Management

    Provide coordination of individualized, timely, cost-effective and integrated services to promote positive clinical outcomes for members. The purpose of WellCare’s Case Management program for our medically compromised population is:

    • 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

    Provide 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).

  • EPSTD Program

    EPSTD Program

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

    Health and Wellness

    Helps members stay healthy by providing access to educational materials and health tips.

  • Vaccines for Children Program

    Vaccines for Children Program

    The New York Vaccines for Children program ensures children receive their vaccines in accordance with Advisory Committee on Immunization Practices (ACIP) guidelines and periodicity schedule.

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Last Updated On: 12/28/2016