Provider Profiling. The HMO must conduct PCP and other Provider profiling activities at least annually. As part of its QAPI Program, the HMO must describe the methodology it uses to identify which and how many Providers to profile and to identify measures to use for profiling such Providers. Provider profiling activities must include, but not be limited to:
Provider Profiling. The MCO must conduct PCP and other Provider profiling activities at least annually. As part of its QAPI Program, the MCO must describe the methodology it uses to identify which and how many Providers to profile and to identify measures to use for profiling such Providers. Provider profiling activities must include, without limitation:
1. developing PCP and Provider-specific reports that include a multi-dimensional assessment of a PCP or Provider’s performance using clinical, administrative, and Member satisfaction indicators of care that are accurate, measurable, and relevant to the enrolled population;
Provider Profiling. 2.7.3.1. The Contractor must conduct profiling activities for PCPs, Behavioral Health Providers, LTSS providers, dental providers, vision providers and, as directed by EOHHS, specialty providers, at least annually. As part of its quality activities, the Contractor must document the methodology it uses to identify which and how many providers to profile and to identify measures to use for profiling such providers.
2.7.3.2. Provider profiling activities must include, but are not limited to:
2.7.3.2.1. Developing provider-specific reports that include a multi- dimensional assessment of a provider‘s performance using clinical, administrative, and Enrollee satisfaction indicators of care that are accurate, measurable, and relevant to the enrolled population;
2.7.3.2.2. Establishing provider, group, or regional benchmarks for areas profiled, where applicable, including Contractor- specific benchmarks, if any;
2.7.3.2.3. Providing feedback to providers regarding the results of their performance and the overall performance of the Provider Network; and
2.7.3.2.4. Designing and implementing quality improvement plans for providers who receive a relatively high denial rate for prospective, concurrent, or retrospective service authorization requests, including referral of these providers to the Network Management staff for education and technical assistance and reporting results annually to EOHHS.
2.7.3.3. The Contractor shall use the results of its provider profiling activities to identify areas of improvement for providers, and/or groups of providers. The Contractor shall:
2.7.3.3.1. Establish provider-specific quality improvement goals for priority areas in which a provider or providers do not meet established Contractor standards or improvement goals;
2.7.3.3.2. Develop and implement incentives, which may include financial and non-financial incentives, to motivate providers to improve performance on profiled measures;
2.7.3.3.3. Conduct on-site visits to Network Providers for quality improvement purposes; and
2.7.3.3.4. At least annually, measure progress on the Provider Network and individual providers‘ progress, or lack of progress, towards meeting such improvement goals.
2.7.3.4. The Contractor shall maintain regular, systematic reports, in a form and format approved by EOHHS, of the above-mentioned provider profiling activities and related Quality Improvement activities pursuant to Section 2.13. Moreover, the Contractor shall submit to EOHHS, upon request, such...
Provider Profiling. DVHA, in collaboration with its IGA partners, will conduct periodic provider profiling activities, including producing information on enrollment, service claims, costs, reimbursements, and outcomes for all health services provided to Global Commitment to Health Demonstration enrollees. Information used in provider profiling will include data from all providers of health services within the IGA partner Departments.
Provider Profiling. The Contractor shall conduct PCD Provider and other Participating Provider profiling activities at least quarterly. As part of its QAPI Program, the Contractor shall describe the methodology it uses to identify which and how many Participating Providers to profile and to identify measures to use for profiling such Providers. Provider profiling activities shall include, without limitation: • Developing PCD Provider and other Provider-specific reports that include a multi-dimensional assessment of a PCD Provider or other Participating Provider’s performance using clinical, administrative and Dental Health Plan Enrollee satisfaction indicators of care that are accurate, measurable, and relevant to the enrolled population; • Establishing PCD Provider, other Participating Provider, group, service area, or regional benchmarks for areas profiled, where applicable; and • Providing feedback to individual PCD Providers and other Participating Providers regarding the results of their performance and the overall performance of the Contractor’s Participating Provider network.
Provider Profiling. The STAR+PLUS MMP must conduct PCP and other Provider profiling activities at least annually. As part of its QAPI Program, the STAR+PLUS MMP must describe the methodology it uses to identify which and how many Providers to profile and to identify measures to use for profiling such Providers. Provider profiling activities must include, without limitation:
Provider Profiling. The STAR+PLUS MMP must conduct PCP and other Provider profiling activities at least annually. As part of its QAPI Program, the STAR+PLUS MMP must describe the methodology it uses to identify which and how many Providers to profile and to identify measures to use for profiling such Providers. Provider profiling activities must include, without limitation: 360
2.7.5.2.1. The STAR+PLUS MMP must have workforce development capacity to work with agencies contracted to provide community attendant care services to improve recruitment and retention of Provider agency community attendant staff. 360
2.7.5.2.2. Developing PCP and Provider-specific reports that include a multi-dimensional assessment of a PCP or Provider’s performance using clinical, administrative, and Enrollee satisfaction indicators of care that are accurate, measurable, and relevant to the enrolled population; 360
Provider Profiling.
1. The Contractor must conduct profiling activities for PCPs, Behavioral Health Providers, LTSS Providers, dental providers, vision providers and, as directed by EOHHS, specialty providers, at least annually. As part of its quality activities, the Contractor must document the methodology it uses to identify which and how many providers to profile and to identify measures to use for profiling such providers.
a. Developing provider-specific reports that include a multi-dimensional assessment of a provider’s performance using clinical, administrative, and Enrollee satisfaction indicators of care that are accurate, measurable, and relevant to the enrolled population;
Provider Profiling. 1. The Contractor must conduct profiling activities for PCPs, Behavioral Health Providers, LTSS Providers, dental providers, vision providers and, as directed by EOHHS, specialty providers, at least annually. As part of its quality activities, the Contractor must document the methodology it uses to identify which and how many providers to profile and to identify measures to use for profiling such providers. Provider profiling activities must include, but are not limited to:
a. Developing provider-specific reports that include a multi-dimensional assessment of a provider’s performance using clinical, administrative, and Enrollee satisfaction indicators of care that are accurate, measurable, and relevant to the enrolled population;
Provider Profiling. The HMO must conduct PCP and other Provider profiling activities at least annually. As part of its QAPI Program, the HMO must describe the methodology it uses to identify which and how many Providers to profile and to identify measures to use for profiling such Providers. Provider profiling activities must include, but not be limited to: 1 Developing PCP and Provider-specific reports that include a multi-dimensional assessment of a PCP or Provider’s performance using clinical, administrative, and Member satisfaction indicators of care that are accurate, measurable, and relevant to the enrolled population; 2 Establishing PCP, Provider, group, Service Area or regional Benchmarks for areas profiled, where applicable, including STAR, STAR+PLUS, CHIP and CHIP Perinatal Program-specific Benchmarks, where appropriate; and 3 Providing feedback to individual PCPs and Providers regarding the results of their performance and the overall performance of the Provider Network.
