Provider Resources

The Quality Review Process

Our Quality Assurance (QA) team is passionate about delivering the same excellent access and quality of clinical care to our members that anyone would want for their own families. We pursue this goal through the continuous quality improvement plan and by partnering with providers to support and promote service excellence.

Our QA team supports the development, implementation and monitoring of the Quality Improvement Program (QIP). Our QIP includes surveys designed to ensure are members receive the highest quality of care. The most frequent types of surveys our QA team conducts are:

  • Clinical documentation reviews
  • Environmental, health and safety assessments
  • Workforce training and staff development surveys
  • Member interviews

In addition to surveys, the QA team collects, aggregates, analyzes, reports, intervenes and monitors a number of quality improvement activities to ensure quality of service, quality of clinical care, continuity and coordination of care, clinical quality improvement and safety of clinical care. The results of these quality activities over the last year have produced a number of outcomes that include but are not limited to the following:

  • Complaints across the systems are very low (0.65 complaints per 1000 members)
  • Care Coordinating Agencies exceed standards for providing intakes to new members under routine circumstances
  • Care Coordinating Agencies consistently demonstrate the ability to see members for urgent intakes within 48 hours
  • The Practitioner Network is consistently available for active members in urban and rural settings
  • Our call center consistently demonstrates better than national standard expectations for average speed of answer and minimal abandoned/dropped calls
  • Provider survey information reflects a 91.4% satisfaction with the Networks.