Quality Measures A-Z
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A
- Access to Preventive/ Ambulatory Health Services for Adult Medicaid Members with SMI
- Access to Preventive/ Ambulatory Health Services for Adult Medicaid Members with SUD in a Calendar Year
- Access to Preventive/ Ambulatory Health Services for Adult Medicaid Members with SUD in a Calendar Year by Subpopulation
- Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA)
- Adherence to Non-Infused Biologic Medications Used to Treat Rheumatoid Arthritis (PDC-RA)
- Adolescent Well-Care Visits (AWC)
- Adult BMI Assessment (ABA)
- Adults' Access to Preventive/Ambulatory Health Services (AAP)
- Ambulatory Care (AMB) - Total Medicaid Emergency Department Visits
- Ambulatory Care (AMB) - Total Medicaid Outpatient Visits
- Antidepressant Medication Management (AMM): Effective Acute Phase Treatment
- Antidepressant Medication Management (AMM): Effective Continuation Phase Treatment
- Appropriate Testing for Children With Pharyngitis (CWP)
- Appropriate Testing for Pharyngitis (CWP)
- Appropriate Treatment for Upper Respiratory Infection (URI)
- Asthma in Younger Adults Admission Rate (PQI15, CMS Adult Core Set)
- Asthma Medication Ratio (AMR)
- Average Pharmacy Claim Processing Time
- Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB)
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B
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C
- Cardiac Rehabilitation - Achievement (CRE)
- Cardiac Rehabilitation - Engagement 1 (CRE)
- Cardiac Rehabilitation - Engagement 2 (CRE)
- Cardiac Rehabilitation - Initiation (CRE)
- Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC)
- Care Management Comprehensive Assessment Attempts Completed within 30 Days
- Care Management Comprehensive Assessment Results within 14 Calendar Days
- Care Management Outreach to High-Risk/High-Need Members
- Cervical Cancer Screening (CCS)
- Child and Adolescent Well-Care Visits (WCV)
- Childhood Immunization Status (CIS): Combination 10
- Childhood Immunization Status (CIS): Combination 3
- Childhood Immunization Status (CIS): Combination 7
- Children and Adolescents' Access to Primary Care Practitioners (CAP): A. Age 12-24 Months
- Children and Adolescents' Access to Primary Care Practitioners (CAP): B. Age 25 Months - 6 Years
- Children and Adolescents' Access to Primary Care Practitioners (CAP): C. Age 7-11 Years
- Children and Adolescents' Access to Primary Care Practitioners (CAP): D. Age 12-19 Years
- Children with Chronic Conditions: Child has Emotional, Developmental, or Behavioral Problem for which They Need/Get Treatment or Counseling (CAHPS® - Child)
- Children with Chronic Conditions: Child Limited or Prevented in Ability to do Things Most Children of Same Age Can Do (CAHPS® - Child)
- Children with Chronic Conditions: Child Needs/Gets Special Therapy (e.g., Physical, Occupational, or Speech) (CAHPS® - Child)
- Children with Chronic Conditions: Child Needs/Uses More Health Care than Usual for Children of Same Age (CAHPS® - Child)
- Children with Chronic Conditions: Child Needs/Uses Prescribed Medicine Due Health Condition (CAHPS® - Child)
- Chlamydia Screening in Women (CHL)
- Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate (PQI05, CMS Adult Core Set)
- Colorectal Cancer Screening (COL, CMS Adult Core Set)
- Community Hospital Discharges for Mental Health-Related Conditions - Follow-up Visit within 30 Days of Discharge
- Community Hospital Discharges for Mental Health-Related Conditions - Follow-up Visit within 7 Days of Discharge
- Community Hospital or APRT Readmissions for Mental Health Conditions at 180 Days
- Community Hospital or APRT Readmissions for Mental Health Conditions at 30 Days
- Community Hospital Readmissions for Mental Health-Related Conditions within 180 Days of Discharge
- Community Hospital Readmissions for Mental Health-Related Conditions within 30 Days of Discharge
- Comprehensive Diabetes Care (CDC): Blood Pressure Control (<140/90 mm Hg)
- Comprehensive Diabetes Care (CDC): Eye Exam
- Comprehensive Diabetes Care (CDC): HbA1c Control (<8.0%)
- Comprehensive Diabetes Care (CDC): HbA1c Poor Control (>9.0%)
- Comprehensive Diabetes Care (CDC): HbA1c Testing
- Comprehensive Diabetes Care (CDC, Hybrid Specification): Medical Attention for Nephropathy
- Concurrent Use of Opioids and Benzodiazepines (CUOB, CMS Adult Core Set)
- Contraceptive Care – All Women : Long-Acting Reversible Method of Contraception (LARC) (CCW, CMS Adult and Child Core Set)
- Contraceptive Care – All Women - Most Effective or Moderately Effective Contraception (CCW, CMS Adult and Child Core Set)
- Contraceptive Care – Postpartum Women: Long-Acting Reversible Method of Contraception (LARC) – 3 days (CCP, CMS Adult and Child Core Sets)
- Contraceptive Care – Postpartum Women: Long-Acting Reversible Method of Contraception (LARC) – 90 days (CCP, CMS Adult and Child Core Sets)
- Contraceptive Care – Postpartum Women: Most or Moderately Effective Contraception – 3 Days by Age Group (CCP, CMS Adult and Child Core Sets)
- Contraceptive Care – Postpartum Women: Most or Moderately Effective Contraception – 90 days by Age Group (CCP, CMS Adult and Child Core Sets)
- Controlling High Blood Pressure (CBP)
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D
- Dental Claims Quality Assurance: Dental Claims Financial Accuracy
- Dental Claims Quality Assurance: Dental Claims Payment Accuracy
- Dental Claims Quality Assurance: Dental Claims Processing Accuracy
- Dental Member Communications: Calls Abandoned
- Dental Member Communications: Calls Returned by the Next Business Day
- Dental Member Communications: Reasons for Telephone Inquiries
- Dental Member Communications: Speed to Answer Within 30 Seconds
- Dental Provider Communications: Calls Abandoned
- Dental Provider Communications: Calls Returned by Next Business Day
- Dental Provider Communications: Reasons for Telephone Inquiries
- Dental Provider Communications: Speed to Answer within 30 Seconds
- Dental Service, Equipment and Supply Service Authorization Timely Determination Rate: New Routine Requests
- Dental Service, Equipment and Supply Service Authorization Timely Determination Rate: Post-Delivery Requests
- Dental Service, Equipment and Supply Service Authorization Timely Determination Rate: Urgent Requests
- Developmental Screening in the First Three Years of Life (DEV, CMS Child Core Set)
- Diabetes Care for People with Serious Mental Illness - HA1c Testing Poor Control (>9%) (HPCMI, CMS Adult Core Set)
- Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)
- Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)
- Diabetes Short-Term Complications Admission Rate (PQI01,CMS Adult Core Set)
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E
- ED Visits for Mental Health Preceded by NH Hospital Stay in Past 30 Days
- Engagement of Alcohol Abuse or Dependence Treatment (IET)
- Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
- Engagement of Opioid Abuse or Dependence Treatment (IET)
- Engagement of Other Drug Abuse or Dependence Treatment (IET)
- Eye Exam for Patients With Diabetes (EED)
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F
- Family and Friends Program NEMT Legs
- Family and Friends Program NEMT Legs for Adult Dental Services
- Flu Vaccinations for Adults Ages 18 - 64 (FVA) (CAHPS® - Adult)
- Follow-up After Emergency Department Visit for Alcohol and Other Drug Dependence (FUA) Within 07 days
- Follow-up After Emergency Department Visit for Alcohol and Other Drug Dependence (FUA) within 30 days
- Follow-up after Emergency Department Visit for Mental Illness (FUM) within 07 Days
- Follow-up after Emergency Department Visit for Mental Illness (FUM) within 30 Days
- Follow-up After Emergency Department Visit for Mental Illness (FUM) Within 30 days by Age
- Follow-up After Emergency Department Visit for Mental Illness (FUM) Within 7 days by Age
- Follow-Up after High-Intensity Care for Substance Use Disorder (FUI) within 07 Days
- Follow-Up after High-Intensity Care for Substance Use Disorder (FUI) within 30 Days
- Follow-Up After Hospitalization for Mental Illness (FUH) Within 07 Days
- Follow-Up After Hospitalization for Mental Illness (FUH) within 07 Days by Age
- Follow-Up After Hospitalization for Mental Illness (FUH) within 30 Days
- Follow-Up After Hospitalization for Mental Illness (FUH) within 30 Days by Age
- Follow-Up Care for Adult Medicaid Beneficiaries Who are Newly Prescribed an Antipsychotic Medication
- Follow-Up Care for Children Prescribed ADHD Medication (ADD): Continuation and Maintenance Phase
- Follow-Up Care for Children Prescribed ADHD Medication (ADD): Initiation Phase
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G
- Getting Care Quickly: Days to Get Appointment For Check-up or Routine Care (CAHPS® - Adult)
- Getting Care Quickly: Days to Get Appointment For Check-up or Routine Care (CAHPS® - Child)
- Getting Care Quickly: Days to Get Appointment When Care Needed Right Away (CAHPS® - Adult)
- Getting Care Quickly: Days to Get Appointment When Care Needed Right Away (CAHPS® - Child)
- Getting Care Quickly: Getting Appointment with Specialist as Soon as Needed - Usually or Always (CAHPS® - Adult)
- Getting Care Quickly: Getting Appointment with Specialist as Soon as Needed - Usually or Always (CAHPS® - Child)
- Getting Care Quickly: Getting Needed Care from a Doctor's Office or Clinic During Evenings, Weekends, or Holidays - Usually or Always (CAHPS® - Adult)
- Getting Care Quickly: Getting Needed Care from a Doctor's Office or Clinic During Evenings, Weekends, or Holidays - Usually or Always (CAHPS® - Child)
- Getting Care Quickly: Getting Needed Care Right Away - Usually or Always (CAHPS® - Adult)
- Getting Care Quickly: Getting Needed Care Right Away - Usually or Always (CAHPS® - Child)
- Getting Care Quickly: Getting Routine or Check-up Appointments as Soon as They Were Needed - Usually or Always (CAHPS® - Adult)
- Getting Care Quickly: Getting Routine or Check-up Appointments as Soon as They Were Needed - Usually or Always (CAHPS® - Child)
- Getting Needed Care: Care Coordination for More than One Kind of Health Care Provider or Service (CAHPS® - Child)
- Getting Needed Care: Ease In Getting Care, Tests, and Treatment - Usually or Always (CAHPS® - Adult)
- Getting Needed Care: Ease In Getting Care, Tests, and Treatment - Usually or Always (CAHPS® - Child)
- Getting Needed Care: Ease in Getting Prescription Medicines - Usually or Always (CAHPS® - Child)
- Getting Needed Care: Ease in Getting Special Medical Equipment or Devices for Child - Usually or Always (CAHPS® - Child)
- Getting Needed Care: Ease in Getting Special Therapy for their Child - Usually or Always (CAHPS® - Child)
- Getting Needed Care: Ease in Getting Treatment or Counseling for an Emotional, Developmental, or Behavioral Problem - Usually or Always (CAHPS® - Child)
- Getting Needed Care: Getting Questions Answered by Doctors or Other Health Providers - Usually or Always (CAHPS® - Child)
- Getting Needed Care: Got Care from a Doctor or Other Health Provider Besides Their Personal Doctor (CAHPS® - Adult)
- Getting Needed Care: Got Care from a Doctor or Other Health Provider Besides Their Personal Doctor (CAHPS® - Child)
- Getting Needed Care: Got Help Needed From Child's Doctors or Other Health Providers to Contact Child's School or Daycare (CAHPS® - Child)
- Getting Needed Care: Health Plan, Doctor's Office, or Clinic Helped Get Prescription Medicines (CAHPS® - Child)
- Getting Needed Care: Health Plan, Doctor's Office, or Clinic Helped Get Special Medical Equipment or Devices (CAHPS® - Child)
- Getting Needed Care: Health Plan, Doctor's Office, or Clinic Helped Get Special Therapy (CAHPS® - Child)
- Getting Needed Care: Health Plan, Doctor's Office, or Clinic Helped Get Treatment or Counseling for an Emotional, Developmental, or Behavioral Problem (CAHPS® - Child)
- Getting Needed Care: Needed Child's Doctors or Other Health Providers to Contact Child's School or Daycare (CAHPS® - Child)
- Getting Needed Care: Telehealth Visits as Helpful as In-Person Visit (CAHPS® - Adult)
- Getting Needed Care: Telehealth Visits as Helpful as In-Person Visit (CAHPS® - Child)
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H
- Health Plan Complaint Process Awareness (CAHPS® - Adult)
- Health Plan Complaint Process Awareness (CAHPS® - Child)
- Health Plan Customer Service Provided Information or Help - Usually or Always (CAHPS® - Adult)
- Health Plan Customer Service Provided Information or Help - Usually or Always (CAHPS® - Child)
- Health Plan Customer Service Treated Caregiver with Courtesy and Respect - Usually or Always (CAHPS® - Child)
- Health Plan Customer Service Treated Member with Courtesy and Respect - Member's Health Plan- Usually or Always (CAHPS® - Adult)
- Heart Failure Admission Rate (PQI08, CMS Adult Core Set)
- Hemoglobin A1c Control for Patients with Diabetes: HbA1c Control (<8.0%) (HBD)
- Hemoglobin A1c Control for Patients with Diabetes: HbA1c Poor Control (>9.0%) (HBD)
- How Well Doctors Communicate: Child Able to Talk with Doctors about His or Her Health Care (CAHPS® - Child)
- How Well Doctors Communicate: Feel Comfortable Speaking To Doctor or Other Health Provider About Personal or Family Problems with Alcohol or Other Drugs (CAHPS® - Adult)
- How Well Doctors Communicate: Personal Doctor Asked About Feeling Sad, Empty, or Depressed (CAHPS® - Adult)
- How Well Doctors Communicate: Personal Doctor Explained Things in a Way Easy for Child to Understand - Usually or Always (CAHPS® - Child)
- How Well Doctors Communicate: Personal Doctor Explained Things in Way Easy to Understand - Usually or Always (CAHPS® - Adult)
- How Well Doctors Communicate: Personal Doctor Explained Things - Usually or Always (CAHPS® - Child)
- How Well Doctors Communicate: Personal Doctor Listened Carefully - Usually or Always (CAHPS® - Adult)
- How Well Doctors Communicate: Personal Doctor Listened Carefully - Usually or Always (CAHPS® - Child)
- How Well Doctors Communicate: Personal Doctor Showed Respect - Usually or Always (CAHPS® - Adult)
- How Well Doctors Communicate: Personal Doctor Showed Respect - Usually or Always (CAHPS® - Child)
- How Well Doctors Communicate: Personal Doctor Spent Enough Time with Child - Usually or Always (CAHPS® - Child)
- How Well Doctors Communicate: Personal Doctor Spent Enough Time with Member - Usually or Always (CAHPS® - Adult)
- How Well Doctors Communicate: Personal Doctor Talked with Caregiver about How Child is Feeling, Growing, or Behaving (CAHPS® - Child)
- How Well Doctors Communicate: Personal Doctor Understands How Health Conditions Affect Child's Day-to-Day Life (CAHPS® - Child)
- How Well Doctors Communicate: Personal Doctor Understands How Health Conditions Affect Child's Family's Day-to-Day Life (CAHPS® - Child)
- How Well Doctors Communicate: Personal Doctor Up-to-Date about Care from other Doctors or Health Providers - Usually or Always (CAHPS® - Adult)
- How Well Doctors Communicate: Personal Doctor Up-to-Date about Care from other Doctors or Health Providers - Usually or Always (CAHPS® - Child)
- How Well Doctors Communicate: Talked with Personal Doctor about Things in Life Causing Worry or Stress (CAHPS® - Adult)
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I
- Immunizations for Adolescents (IMA):
- Immunizations for Adolescents (IMA): Combination 1
- Immunizations for Adolescents (IMA): Combination 2
- Immunizations for Adolescents (IMA): Meningococcal Vaccine
- Immunizations for Adolescents (IMA): Tdap/Td Vaccine
- Initiation of Alcohol Abuse or Dependence Treatment (IET)
- Initiation of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
- Initiation of Opioid Abuse or Dependence Treatment (IET)
- Initiation of Other Drug Abuse or Dependence Treatment (IET)
- Interest on Late Paid Dental Claims
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K
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L
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M
- MCO Contacts and Contact Attempts Following ED Discharges for SUD
- Medical Assistance with Smoking and Tobacco Use Cessation: Advising Smokers and Tobacco Users to Quit (MSC, CMS Adult Core Set)
- Medical Assistance with Smoking and Tobacco Use Cessation: Discussing Cessation Medications (MSC, CMS Adult Core Set)
- Medical Assistance with Smoking and Tobacco Use Cessation: Discussing Cessation Strategies (MSC, CMS Adult Core Set)
- Medical Service, Equipment and Supply Post-Delivery Service Authorization Timely Determination Rate
- Medical Service, Equipment and Supply Service Authorization Timely Determination Rate: New Routine Requests
- Medical Service, Equipment and Supply Service Authorization Timely Determination Rate: Urgent Requests
- Medication Management for People With Asthma (MMA): Medication Compliance 50%
- Medication Management for People With Asthma (MMA): Medication Compliance 75%
- Member Appeals Received
- Member Communications: Behavioral Health Crisis Calls
- Member Communications: Calls Abandoned
- Member Communications: Calls Returned by the Next Business Day
- Member Communications: Reasons for Telephone Inquiries
- Member Communications: Speed to Answer Within 30 Seconds
- Member Dental Appeals Received
- Member Dental Grievances Received
- Member Dental Services Authorized within 72 Hours Following a Reversed Appeal
- Member Grievances Received
- Member Non-Emergent Medical Transportation Grievance Dispositions Resolved Within 30 Calendar Days
- Member Retention in SUD Treatment
- Members Enrolled in Care Management as of the Last Day of the Month
- Members Enrolled in Care Management at Any Time During the Month
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) - Blood Glucose and Cholesterol Testing
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) - Blood Glucose Testing
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) - Cholesterol Testing
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N
- NEMT Call Center - Abandoned Calls
- NEMT Call Center - Calls Returned by Next Business Day
- NEMT Call Center - Hold Status Less Than 4 Minutes
- NEMT Call Center - Speed to Answer within 90 Seconds
- NEMT Claims Quality Assurance: Claims Processing Accuracy
- NEMT Legs Delivered by Covered Medical Service
- NEMT Request Authorization Approvals by Mode of Transportation
- NEMT Scheduled Legs Assigned by Broker within Advanced Notice Period
- NEMT Timely Claims Processing
- Neonatal Abstinence Syndrome Engagement in Care Management
- Neonatal Abstinence Syndrome Referrals to Care Management
- NH Hospital Discharges - Discharge Plan Provided to Aftercare Provider within 7 Calendar Days of Member Discharge
- NH Hospital Discharges - Follow-up Visit within 30 Days of Discharge
- NH Hospital Discharges - Follow-up Visit within 7 Days of Discharge
- NH Hospital Discharges - MCO Contacts and Contact Attempts
- NH Hospital Discharges - Member Received Discharge Instruction Sheet
- NH Hospital Discharges - New CMHC Patient Had Intake Appointment with CMHC within 7 Calendar Days of Discharge
- Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS)
- Number of Health Care Visits (CAHPS® - Adult)
- Number of Health Care Visits (CAHPS® - Child)
- Number of Specialists Child Talked To (CAHPS® - Child)
- Number of Specialists Member Talked To (CAHPS® - Adult)
- Number of Visits to Personal Doctor (CAHPS® - Adult)
- Number of Visits with Personal Doctor (CAHPS® - Child)
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P
- Persistence of Beta-Blocker Treatment After a Heart Attack (PBH)
- Pharmacotherapy for Opioid Use Disorder (POD)
- Pharmacotherapy Management of COPD Exacerbation (PCE): Bronchodilator
- Pharmacotherapy Management of COPD Exacerbation (PCE): Systemic Corticosteroid
- Pharmacy Service Authorization Timely Determination Rate
- Pharmacy Utilization Management: Generic Drug Substitution
- Pharmacy Utilization Management: Generic Drug Utilization
- Pharmacy Utilization Management: Generic Drug Utilization Adjusted for Preferred PDL Brands
- Polypharmacy Monitoring: Adults with 5 or More Prescriptions for 60 Consecutive Days
- Polypharmacy Monitoring: Children with 4 or More Prescriptions for 60 Consecutive Days
- Prenatal and Postpartum Care (PPC): Postpartum Care
- Prenatal and Postpartum Care (PPC): Timeliness of Prenatal Care
- Prescription Medications Usage: Personal Doctor Talked about All Taken - Usually or Always (CAHPS® - Child)
- Prescription Medication Usage: Personal Doctor Talked about All Taken - Usually or Always (CAHPS® - Adult)
- Private Duty Nursing: Authorized Hours for Adults Delivered and Billed by Quarter
- Private Duty Nursing: Authorized Hours for Children Delivered and Billed by Quarter
- Professional and Facility Medical Claim Processing Results
- Proportion of Days Covered - Adherence to Long-Acting Inhaled Bronchodilator Agents in COPD Patients (PDC-COPD)
- Proportion of Days Covered - Adherence to Non-Infused Disease Modifying Agents Used to Treat Multiple Sclerosis (PDC-MS)
- Proportion of Days Covered - Antiretroviral Medications (PDC-ARV)
- Proportion of Days Covered - Beta-Blockers (PDC-BB)
- Proportion of Days Covered - Calcium Channel Blockers (PDC-CCB)
- Proportion of Days Covered Composite (PDC-CMP)
- Proportion of Days Covered - Diabetes All Class Rate (PDC-DR)
- Proportion of Days Covered (PDC) - Adherence to Direct-Acting Oral Anticoagulants (PDC-DOAC)
- Proportion of Days Covered - Renin Angiotensin System Antagonists (PDC-RASA)
- Proportion of Days Covered - Statins (PDC-STA)
- Provider Communications: Calls Abandoned
- Provider Communications: Calls Returned by Next Business Day
- Provider Communications: Reasons for Telephone Inquiries
- Provider Communications: Speed to Answer within 30 Seconds
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R
- Rating of Health Care - 8, 9 or 10 (CAHPS® - Adult)
- Rating of Health Care - 8, 9 or 10 (CAHPS® - Child)
- Rating of Health Plan - 8, 9, or 10 (CAHPS® - Adult)
- Rating of Health Plan - 8, 9, or 10 (CAHPS® - Child)
- Rating of Overall Health - Very Good or Excellent (CAHPS® - Adult)
- Rating of Overall Health - Very Good or Excellent (CAHPS® - Child)
- Rating of Overall Mental or Emotional Health - Very Good or Excellent (CAHPS® - Adult)
- Rating of Overall Mental or Emotional Health - Very Good or Excellent (CAHPS® - Child)
- Rating of Personal Doctor - 8, 9 or 10 (CAHPS® - Adult)
- Rating of Personal Doctor - 8, 9 or 10 (CAHPS® - Child)
- Rating of Specialist Child Talked to Most Often - 8, 9 or 10 (CAHPS® - Child)
- Rating of Specialist Member Talked to Most Often - 8, 9 or 10 (CAHPS® - Adult)
- Readmissions among Members with SUD
- Readmissions among Members with SUD by Subpopulation
- Readmissions for Mental Health Conditions within 30 Days
- Readmissions to NH Hospital within 180 Days
- Readmissions to NH Hospital within 30 Days
- Requests for Assistance Accessing Dentists by County
- Requests for Assistance Accessing MCO Designated Primary Care Providers by County
- Requests for Assistance Accessing non-MCO Designated Physician/APRN Specialists by County
- Requests for Assistance Accessing Oral Surgeons by County
- Resolution of All Appeals within 45 Calendar Days
- Resolution of All Member Dental Appeals within 45 Calendar Days
- Resolution of Appeals by Disposition Type
- Resolution of Expedited Appeals within 72 Hours
- Resolution of Expedited Member Dental Appeals within 72 Hours
- Resolution of Extended Standard Appeals within 44 Calendar Days
- Resolution of Extended Standard Member Dental Appeals within 45 Calendar Days
- Resolution of Member Dental Appeals by Disposition Type
- Resolution of Provider Appeals within 30 Calendar Days
- Resolution of Standard Appeals within 30 Calendar Days
- Resolution of Standard Member Dental Appeals within 30 Calendar Days
- Results of Scheduled NEMT Legs by Outcome
- Results of Scheduled NEMT Legs for Adult Dental Services by Outcome
- Risk of Continued Opioid Use (COU) >= 15 Days by Age
- Risk of Continued Opioid Use (COU) >= 30 Days by Age
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S
- Safety Monitoring - Opioid Prescriptions Meeting NH DHHS Morphine Equivalent Dosage Prior Authorization Compliance
- Scheduled NEMT Legs Delivered On Time for Adult Dental Services
- Screening for Depression and Follow-Up Plan (CDF, CMS Adult and Child Core Set)
- Service Authorization Denials for Waiver & Non-HCBC Waiver Populations
- Service Authorizations: Physical, Occupational & Speech Therapy Service Authorization Denials by Waiver & Non-HCBC Waiver Populations
- Services Authorized within 72 Hours Following a Reversed Appeal
- Statin Therapy for Patients With Cardiovascular Disease (SPC): Received Statin Therapy
- Statin Therapy for Patients With Cardiovascular Disease (SPC): Statin Adherence 80%
- Statin Therapy for Patients With Diabetes (SPD): Received Statin Therapy
- Statin Therapy for Patients With Diabetes (SPD): Statin Adherence 80%
- Successful Completion of MCO Health Risk Assessment
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T
- Timeliness of Scheduled and Delivered FFS NEMT Legs
- Timeliness of Scheduled and Delivered NEMT Legs
- Timely Processing of All Clean Dental Claims: Ninety Days of Receipt
- Timely Processing of All Clean Dental Claims: Thirty Days of Receipt
- Timely Processing of All Clean Provider Claims: Ninety Days of Receipt
- Timely Processing of All Clean Provider Claims: Thirty Days of Receipt
- Timely Processing of All Member Dental Grievances
- Timely Processing of Electronic Provider Claims: Fifteen Days of Receipt
- Timely Processing of Grievances
- Timely Processing of Non-Electronic Provider Claims: Thirty Days of Receipt
- Timely Provider Credentialing - PCPs
- Timely Provider Credentialing - Primary Dental Provider
- Timely Provider Credentialing - Specialty Dental Providers
- Timely Provider Credentialing - Specialty Providers
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U
- Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP)
- Use of Imaging Studies for Low Back Pain (LBP)
- Use of Opioids at High Dosage (HDO)
- Use of Opioids from Multiple Providers (UOP): Multiple Pharmacies
- Use of Opioids from Multiple Providers (UOP): Multiple Prescribers
- Use of Opioids from Multiple Providers (UOP): Multiple Prescribers and Multiple Pharmacies
- Use of Pharmacotherapy for Opioid Use Disorder - Buprenorphine (OUD, CMS Adult Core Set)
- Use of Pharmacotherapy for Opioid Use Disorder - Long-Acting, Injectable Naltrexone (OUD, CMS Adult Core Set)
- Use of Pharmacotherapy for Opioid Use Disorder - Methadone (OUD, CMS Adult Core Set)
- Use of Pharmacotherapy for Opioid Use Disorder - Oral Naltrexone (OUD, CMS Adult Core Set)
- Use of Pharmacotherapy for Opioid Use Disorder - Total (OUD, CMS Adult Core Set)
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W
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC, Hybrid Specification): Counseling for Nutrition
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC, Hybrid Specification): Counseling for Physical Activity
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC, Hybrid Specification): Evidence of BMI Percentile Documentation
- Well-Child Visits in the First 15 Months of Life (W15): 6 or More Visits
- Well-Child Visits in the First 30 Months of Life (W30) - Visits for Age 15 Months–30 Months
- Well-Child Visits in the First 30 Months of Life (W30) - Visits in the First 15 Months