Skip to main content

Quality

WellCare of South Carolina wants to ensure that our members have access to quality, cost-effective health care solutions. Our Quality Improvement (QI) program aims to improve patient safety and care so our members can enhance their quality of life by staying healthy or managing their chronic health problems. 

HEDIS®

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

We Need Your Help in Closing the Gap

The pediatric body mass index (BMI) is one of the HEDIS® measures that will require our focus this year. We appreciate the care that you provide to our members, whether they are sick or well. Our members usually receive a height and weight check with each office visit. However, if there is no BMI percentile with the proper code, the Care Gap remains open. We are aware that you are providing the service and we want you to get credit for it. Close the gap by coding the BMI percentile for each office visit that our member receives.

Pediatric BMI ICD-10 Code
Pediatric BMI (Ages 3-17)  ICD-10 Code
Less than 5th percentile for age Z68.51
5th percentile to less than 85th percentile for age Z68.52
85th percentile to less than 95th percentile for age  Z68.53
Greater than or equal to 95th percentile for age Z68.54

To identify and close gaps in members’ health care, log in to the provider portal and access HEDIS Online Tools. If you don’t have an account, you can register online. 

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.

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

Important information for Medicaid providers.

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

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

HEDIS reference guide for Pediatric care.

How to Code for a Well Visit with a Sick Visit

2018 HEDIS At-a-Glance Key Pediatric Measures

Additional Information

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.
  • 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.
contact-us

Need help? We're here for you.

Contact Us
Last Updated On: 10/10/2017