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Quality

Wellcare By ‘Ohana Health Plan Quality Improvement (QI) Program monitors and evaluates the quality, appropriateness, accessibility and availability of health care services.

Medical Records

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®*

HEDIS® is a mandatory process that occurs annually. We've developed this toolkit to help identify required preventive services.

New: HEDIS Measurement Year 2024 Toolkit

HEDIS® Measurement Year Adult Pocket Guide 2024

HEDIS® Measurement Year Adult Pocket Guide 2024

HEDIS® Measurement Year Adult Pocket Guide 2024

HEDIS Measurement Year 2023 Toolkit

HEDIS® Measurement Year Adult Pocket Guide 2023

HEDIS® Measurement Year Adult Pocket Guide 2023

HEDIS® At-a-Glance STARS Measures

Quality Measures

The National Benchmark to measure the Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)

Examples of Centers for Medicare and Medicaid Services Star measures which use statin therapy to evaluate health plans.

Medicare Incentive Programs

Unlock the Benefits of Partnership!

Program Announcement

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EPSTD Program

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.

Provider Participation

Network providers are contractually required to cooperate with quality improvement activities. Providers are also invited to volunteer for the QI Program. Please ᎢᏍᎩᏟᏃᎮᏓ ᏂᎦᏓ if you’re interested in volunteering.

  • EPSTD Program

    EPSTD Program

    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.

  • Provider Participation

    Provider Participation

    Network providers are contractually required to cooperate with quality improvement activities. Providers are also invited to volunteer for the QI Program. Please ᎢᏍᎩᏟᏃᎮᏓ ᏂᎦᏓ if you’re interested in volunteering.

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Y0020_WCM_87476E Last Updated On: 5/7/2024
Wellcare will be performing maintenance on Saturday, May 18, from 6 P.M. EDT to 8 A.M. EDT the next day. You might not be able to access systems or fax during this time. We are sorry for any issues this may cause. Thank you for your patience. If you need assistance, contact us.
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