Common use of Cost and Quality Information Clause in Contracts

Cost and Quality Information. Making cost and quality information available to members increases transparency and has the potential to reduce costs and improve quality. The Contractor shall make cost and quality information available to members in order to facilitate more responsible use of health care services and inform health care decision-making. Example cost information includes average cost of common services, urgent versus emergent care costs, etc. For services which may be at risk for improper payments, the Contractor must develop processes to verify with members that said targeted services billed by providers were actually received by said members, in order to obtain direct verification of services rendered and increase oversight. Contractor’s processes and procedures must be identified in Contractor’s Program Integrity Plan, identified in Section 7.1. Specific services for member verification may be identified by the OMPP PI Unit and may change based upon fraud trends. Processes for verifying services with members shall be included in the Contractor’s Program Integrity Plan. The Contractor shall provide a member portal with access to electronic EOB statements for Hoosier Healthwise members. Provider quality information shall also be made available to members. The Contractor shall capture quality information about its network providers, and must make this information available to members. In making the information available to members, the Contractor shall identify any limitations of the data. The Contractor shall also refer members to quality information compiled by credible external entities (e.g., Hospital Compare, Leap Frog Group, etc.).

Cost and Quality Information. Making cost and quality information available to members increases transparency and has the potential to reduce costs and improve quality. The Contractor shall make cost and quality information available to members in order to facilitate more responsible use of health care services and inform health care decision-making. Example cost information includes average cost of common services, urgent versus emergent care costs, etc. For services which that may be at risk for improper payments, the Contractor must develop processes to verify with members that said targeted services billed by providers were actually received by said members, in order to obtain direct verification of services rendered and increase oversight. Contractor’s processes Processes and procedures must be identified in the Contractor’s Program Integrity Plan, identified in Section 7.17.4.1. Specific services for member verification may be identified by the OMPP PI Unit Section and may change based upon fraud trends. Processes for verifying services with members shall be included in the Contractor’s Program Integrity Plan. The Contractor shall provide a member portal with access to electronic EOB statements for Hoosier Healthwise Care Connect members. Provider quality information shall also be made available to members. The Contractor shall capture quality information about its network providers, providers and must make this information available to members. In making the information available to members, the Contractor shall identify any limitations of the data. The Contractor shall also refer members to quality information compiled by credible external entities (e.g., such as CMS Hospital Compare, Leap Frog Compare or Leapfrog Group, etc.).

Cost and Quality Information. Making cost and quality information available to members increases transparency and has the potential to reduce costs and improve quality. The Contractor shall make cost and quality information available to members in order to facilitate more responsible use of health care services and inform health care decision-making. Example cost information includes average cost of common services, urgent versus emergent care costs, etc. For services which may be at risk for improper payments, the Contractor must develop processes to verify with members that said targeted services billed by providers were actually received by said members, in order to obtain direct verification of services rendered and increase oversight. Contractor’s processes and procedures must be identified in Contractor’s Program Integrity Plan, identified in Section 7.1. Specific services for member verification may be identified by the OMPP FSSA PI Unit and may change based upon fraud trends. Processes for verifying services with members shall be included in the Contractor’s Program Integrity Plan. The Contractor shall provide a member portal with access to electronic EOB statements for Hoosier Healthwise members. Provider quality information shall also be made available to members. The Contractor shall capture quality information about its network providers, and must make this information available to members. In making the information available to members, the Contractor shall identify any limitations of the data. The Contractor shall also refer members to quality information compiled by credible external entities (e.g., Hospital Compare, Leap Frog Group, etc.).