Common use of Measurement Functions Clause in Contracts

Measurement Functions. The system should include: 1. Ability to track review committee(s) functions when case requires next review and/or follow-up. 2. Track access, use and coordination of all services, including Behavioral Health (BH) services. 3. Provide patient satisfaction data through use of enrollee surveys, grievance and appeals processes, etc. When the data produced in compliance with this section reveals evidence of patient grievances with respect to a specific provider, which indicate the possibility that the provider may be engaged in fraud, waste, or abuse, including but not limited to billing for services not rendered, denial of access to care, or lack of quality of care, the data must be referred to the SIU or other FWA triage area and other relevant departments (i.e. Quality Management, Medical Advisory Committee) within 10 business days. 4. Generate HEDIS reports in the version specified by the State.