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The Quality Improvement Program includes initiatives to ensure that members are receiving age-appropriate preventive health screenings and interventions to optimize health.

The information on this page provides useful information and tools for managing patient care based on industry-standard clinical practice guidelines.

    Preventive Depression Screening Program

    This program promotes collaboration, continuity and coordination between medical and behavioral health care.

    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.

    2019 HEDIS Toolkit

    HEDIS® (Healthcare Effectiveness Data and Information Set)


    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


    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?

    Important Information on CPT II and HCPCS Codes

    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.

    Medication Reconciliation Post-Discharge (MRP): This HEDIS measure ensures that members who are discharged from the hospital have their medications reviewed by a prescribing practitioner, clinical pharmacist or registered nurse within 30 days of discharge. An outpatient visit is not required, but is highly encouraged.

    This guide alerts you to important preventive care and services that you can provide to patients to help boost Star Ratings.

    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

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


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    Last Updated On: 2/4/2019