Wellcare By ‘Ohana Health Plan Quality Improvement (QI) Program monitors and evaluates the quality, appropriateness, accessibility and availability of health care services.
QI may conduct annual medical record audits in physician offices. Patient records are reviewed for evidence that care and screenings have been documented. Complete information is available in the Medicare Advantage Provider manuals.
Clinical Practice Guidelines
Clinical Practice Guidelines (CPGs) outline medical standards of care and best practices.
HEDIS® is a mandatory process that occurs annually. We've developed this toolkit to help identify required preventive services.
New: HEDIS Measurement Year 2022 Toolkit
HEDIS Measurement Year 2021 Toolkit
Sign in to our secure Provider Portal to find out which eligible members are due for EPSDT screenings. If you haven’t registered on our site, please join today. Preventive pediatric health care guidelines for children are located in our clinical practice guidelines.
Network providers are contractually required to cooperate with quality improvement activities. Providers are also invited to volunteer for the QI Program. Please contact us if you’re interested in volunteering.