External Quality Review definition

External Quality Review and “EQR” each means the analysis and evaluation by an EQRO, of aggregated information on quality, timeliness and access to the health care services that Contractor furnishes to its Members, and other EQR-related activities as set forth in 42 CFR 438.358.

External Quality Review means the analysis and evaluation by an EQRO of aggregated information on quality, timeliness and access to the health care services that the Contractor or its subcontractors furnish to enrollees (42 CFR 438.320).

External Quality Review or ”EQR” means the analysis and evaluation by an EQRO, of aggregated information on quality, timeliness and access to the health care services that Contractor furnishes to its Members, and other EQR-related activities as set forth in 42 CFR 438.358.

Examples of External Quality Review in a sentence

• CMS uses a multi-pronged effort to monitor waiver programs, including rate and contract review, site visits, reviews of External Quality Review reports on MCOs/PIHPs, and reviews of Independent Assessments.

• Validating Performance Improvement Projects: Mandatory Protocol for External Quality Review (EQR), Protocol 3, Version 2.0, September 2012.

• Please use Section D to provide evidence of cost-effectiveness.CMS uses a multi-pronged effort to monitor waiver programs, including rate and contract review, site visits, reviews of External Quality Review reports on MCOs/PIHPs, and reviews of Independent Assessments.

• Validation of Performance Measures Reported by the MCO: A Mandatory Protocol for External Quality Review (EQR), Protocol 2, Version 2.0, September, 2012.

• The state must provide summaries of External Quality Review Organization (EQRO) reports, managed care organization (MCO) and state quality assurance monitoring, and any other documentation of the quality of care provided under the demonstration.

More Definitions of External Quality Review

External Quality Review or “EQR” Analysis and evaluation by an EQRO, of aggregated information on quality, timeliness, and access to the health care services that a MCO or their contractors furnish to Medicaid members, as defined in 42 CFR § 438.320.

External Quality Review. Organization (“EQRO”): An organization that meets the competence and independence requirements set forth in 42 CFR 438.354 and performs analysis and evaluation on the quality, timeliness, and access to Covered Services and Benefits to Enrollees with respect to which the Contractor provides Administrative Services under this Contract. Federally Qualified Health Center (“FQHC”) Services: An entity that provides outpatient health programs pursuant to Section 1905(l)(2)(B) of the Social Security Act. Federally Qualified Health Center (“FQHC”) Services: Services furnished to an individual as an outpatient of an FQHC. Fee-for-Service: A method of reimbursement based on payment for specific Covered Services rendered to an Enrollee.

External Quality Review means the analysis and evaluation by an EQRO, of

External Quality Review. Organization or EQRO means an organization that meets the competence and independence requirements set forth in §438.354, and performs external quality review, other EQR-related activities as set forth in §438.358, or both. Family Member means all CHIP eligible individuals associated to same eligibility case number, included in the Eligibility Transmission who are members of the same family. Federal Acquisition Regulation means the regulation found at Title 48 of the Code of Federal Regulations, Chapter 1, Parts 1 through 53. Federal Health Care Program means (1) any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the United States Government (other than the health insurance program under chapter 89 of title 5, United States Code) of the Social Security Act; or (2) any State Health Care program, as defined in Section 1128(h) of the Social Security Act. Federally Qualified Health Center (FQHC) means a community-based organization that qualifies for funding under Section 330 of the Public Health Service Act (PHS), and that provides comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status.

External Quality Review or “EQR” shall mean the review and evaluation by an External Quality Review Organization of information on quality, timeliness, and access to the health care and services that a Managed Care Organization (MCO) or their contractor(s) furnish to Apple Health recipients.

External Quality Review. ’ means the

External Quality Review means the analysis and evaluation by an external quality review organization of the aggregated information on quality, timeliness, and access to the health care services that a managed care organization or the managed care organization's contractor provides to enrollees.