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Quality Measures by Topic
Care Management Program
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Step 1: Select your measure(s).
Filter Measures by One or More Topics
Include uncategorized
Behavioral Health Care
Behavioral Health Care - Adults
Behavioral Health Care - Children
Beneficiary Demographics - Standard Medicaid
Cardiovascular Health Care - Adults
Care Coordination
Care Coordination - Children
CMS Medicaid Adult Core Set - NH Health Protection Program
CMS Medicaid Adult Core Set - Standard Medicaid
Diabetes Health Care - Adults
Grievances and Appeals
Health Services Management - Standard Medicaid
HEDIS Acute and Chronic Care Measures
HEDIS Behavioral Health Care Measures
HEDIS Preventive Care Measures
Hospital Inpatient and Outpatient Care
Hospital Inpatient and Outpatient Care - Adults
Hospital Inpatient and Outpatient Care - Children
Hospital Inpatient and Outpatient Care - NH Health Protection Program Members
Hospital Inpatient and Outpatient Care - Older Adults
Hospital Inpatient and Outpatient Care - Special Needs Population
Immunizations - Children
Long Term Community Based Care
Long Term Community Based Care - Adults
Long Term Community Based Care - Children
Member Experience of Care - Adults
Member Experience of Care - Children
Member Services
Network Adequacy
Office and Clinic Care
Office and Clinic Care - Adults
Office and Clinic Care - Children
Office and Clinic Care - NH Health Protection Program Members
Office and Clinic Care - Older Adults
Office and Clinic Care - Special Needs Population
Pharmacy
Pharmacy - Adults
Pharmacy - Children
Pharmacy - Older Adults
Provider Services
Respiratory Health Care
Respiratory Health Care - Adults
Respiratory Health Care - Children
Screenings - Adults
Screenings - Children
Substance Use Disorder Care
Substance Use Disorder Care - Adults
Substance Use Disorder Care - NH Health Protection Program Members
Well Care - Children
Measures
*
Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA)
Adolescent Well-Care Visits (AWC, Hybrid Specification)
Adolescent Well-Care Visits by Geographic Region - Excluding NHHPP Members
Adolescent Well Care Visits by Geographic Region - Excluding NHHPP Members: A. Metropolitan Counties
Adolescent Well Care Visits by Geographic Region - Excluding NHHPP Members: B. Non-Metropolitan Counties
Adolescent Well Care Visits by Geographic Region - Excluding NHHPP Members: C. Non-NH/Unknown Counties
Adult BMI Assessment (ABA, Administrative Specification)
Adult BMI Assessment (ABA, CMS Adult Core Set)
A. Age 18 to 64 Years
B. Age 65 to 74 Years
Adult BMI Assessment (ABA, Hybrid Specification)
Adult CAHPS®: Customer Service Provided Information or Help: Usually or Always
Adult CAHPS®: Customer Service Treated Member with Courtesy and Respect: Usually or Always
Adult CAHPS®: Days to Get Appointment For Check-up or Routine Care
A. Same Day
B. 1 Day
C. 2 to 3 Days
D. 4 to 7 Days
E. 8 to 14 Days
F. 15 to 30 Days
G. More than 30 Days
Adult CAHPS®: Days to Get Appointment When Care Needed Right Away
A. Same Day
B. 1 Day
C. 2 - 3 Days
D. 4 - 7 Days
E. More than 7 Days
Adult CAHPS®: Doctor or Other Health Provider Talked About What Member Thought was Best for Themselves When Discussing Medicine
Adult CAHPS®: Doctor or Other Health Provider Talked With Member About Reasons Member Might Want to Take a Medicine
Adult CAHPS®: Doctor or Other Health Provider Talked with Member About Reasons Member Might Not Want to Take a Medicine
Adult CAHPS®: Doctor or Other Health Provider Talked with Member about Specific Things the Member Could do to Prevent Illness
Adult CAHPS®: Ease In Getting Care, Tests, and Treatment: Usually or Always
Adult CAHPS®: Ease in Getting Special Medical Equipment: Usually or Always
Adult CAHPS®: Ease in Getting Treatment or Counseling: Usually or Always
Adult CAHPS®: Flu Vaccinations for Adults Ages 18 - 64 (FVA)
Adult CAHPS®: Getting Appointment to See Specialist as Soon as Needed: Usually or Always
Adult CAHPS®: Getting Needed Care Right Away - Usually or Always
Adult CAHPS®: Getting Needed Care from a Doctor's Office or Clinic During Evenings, Weekends, or Holidays - Usually or Always
Adult CAHPS®: Getting Routine or Check-up Appointments as Soon as They Were Needed: Usually or Always
Adult CAHPS®: Heath Plan Forms Easy to Fill Out: Usually or Always
Adult CAHPS®: Member Got Care from a Doctor or Other Health Provider Besides Their Personal Doctor
Adult CAHPS®: Members Reporting a Condition or Problem Lasting at Least 3 months for which They Received Health Care 3 or More Times in the Last 6 Months.
Adult CAHPS®: Number of Specialists Seen
A. None
B. One
C. Two
D. Three
E. Four
F. Five or More Specialists
Adult CAHPS®: Number of Visits to Personal Doctor
A. None
B. One
C. Two
D. Three
E. Four
F. Five to Nine
G. Ten or More
Adult CAHPS®: Percent of Adults Reporting Now Needing or Taking Medicine Prescribed by a Doctor
Adult CAHPS®: Percent of Adults Reporting a Condition or Problem Lasting at Least 3 months for which They Need or Take Medicine Prescribed by a Doctor.
Adult CAHPS®: Personal Doctor Explained Things in a Way That Was Easy to Understand: Usually or Always
Adult CAHPS®: Personal Doctor Listened Carefully: Usually or Always
Adult CAHPS®: Personal Doctor Showed Respect: Usually or Always
Adult CAHPS®: Personal Doctor Spent Enough time with Member: Usually or Always
Adult CAHPS®: Personal Doctor Up-to-Date about Care from other Doctors or Health Providers: Usually or Always
Adult CAHPS®: Rating of Health Care - 8, 9 or 10
Adult CAHPS®: Rating of Health Plan: 8, 9, or 10
Adult CAHPS®: Rating of Overall Health - Very Good or Excellent
Adult CAHPS®: Rating of Overall Mental or Emotional Health - Very Good or Excellent
Adult CAHPS®: Rating of Personal Doctor - 8, 9 or 10
Adult CAHPS®: Rating of Specialist Seen Most Often - 8, 9 or 10
Adult CAHPS®: Written Materials or Internet Provide Information Needed about How Health Plan Works: Usually or Always
Adults’ Access to Preventive/Ambulatory Health Services (AAP)
A: Age 20-44 Years
B: Age 45-64 Years
C. Age 65+ Years
Annual Monitoring for Members on Angiotensin Converting Enzyme inhibitors (ACE) or Angiotensin Receptor Blockers (ARB) (MPM, CMS Adult Core Set)
A. Age 18-64 Years
B. Age 65 and Older
Annual Monitoring for Members on Digoxin (MPM, CMS Adult Core Set)
A. Age 18-64 Years
B. Age 65 and Older
Annual Monitoring for Members on Diuretic (MPM, CMS Adult Core Set)
A. Age 18-64 Years
B. Age 65 and Older
Annual Monitoring for Patients on Persistent Medications (MPM): ACE Inhibitors or ARBs
Annual Monitoring for Patients on Persistent Medications (MPM): Digoxin
Annual Monitoring for Patients on Persistent Medications (MPM): Diuretics
Antidepressant Medication Management (AMM): Effective Acute Phase Treatment
Antidepressant Medication Management (AMM): Effective Continuation Phase Treatment
Antidepressant Medication Management (AMM, CMS Adult Core Set): Effective Acute Phase Treatment
A. Age 18-64 Years
B. Age 65 and Older
Antidepressant Medication Management (AMM, CMS Adult Core Set): Effective Continuation Phase Treatment
A. Age 18-64 Years
B. Age 65 and Older
Appeals Elevated to State Fair Hearing
A. Upheld
B. Reversed by Plan
C. Withdrawn
D. Dismissed
Appeals by Reason Type
A. Denial or Limited Authorization
B. Reduction, Suspension, or Termination of Previously Authorized Service
C. Denial of Payment
D. Failure to Provide Timely Service
E. Untimely Service Authorization
F. Failure of MCO to Act Within NH DHHS Contract Timeframes
G. Other
Appropriate Testing for Children With Pharyngitis (CWP)
Appropriate Treatment for Children With Upper Respiratory Infection (URI)
Asthma Medication Ratio (AMR)
A. Age 5 to 11 Years
B. Age 12 to 18 Years
C. Age 19 to 50 Years
D. Age 51 to 64 Years
Asthma in Younger Adults Admission Rate per 100,000 Enrollee Months (PQI15, CMS Adult Core Set)
Average Pharmacy Claim Processing Time
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB)
Behavioral Health Risk Assessment for Pregnant Women (CMS Child Core Set)
Behavioral Health Utilization: Percent of Discharges Where Patient Had a Visit With a Mental Health Practitioner Within 7 Calendar Days of Discharge - Excluding New Hampshire Health Protection Program Members
Behavioral Health Utilization: Percent of Discharges Where an Attempt Was Made to Contact Member Within 3 Calendar Days of Discharge - Excluding New Hampshire Health Protection Program Members
Behavioral Health Utilization: Percent of Readmission to New Hampshire Hospital within 30 days of Discharge - Excluding New Hampshire Health Protection Program Members
Behavioral Health Utilization: Percent of Readmissions at 180 days - Excluding New Hampshire Health Protection Program Members
Breast Cancer Screening (BCS, CMS Adult Core Set)
A. Age 50-64 Years
B. Age 65-74 Years
Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC)
Cervical Cancer Screening (CCS, Hybrid Specification)
Cervical Cancer Screening (CMS Adult Core Set) - Excluding NHHPP Members
Child CAHPS®: Care Coordination for More than One Kind of Health Care Provider or Service
Child CAHPS®: Child Able to Talk with Doctors about His or Her Health Care
Child CAHPS®: Child Got Care from a Doctor or Other Health Provider Besides Their Personal Doctor
Child CAHPS®: Child Limited or Prevented in Ability to do Things Most Children of Same Age Can Do
Child CAHPS®: Child Needs/Gets Special Therapy (e.g., Physical, Occupational, or Speech)
Child CAHPS®: Child Needs/Uses More Health Care than Usual for Children of Same Age
Child CAHPS®: Child Needs/Uses Prescribed Medicine Due Health Condition
Child CAHPS®: Child has Emotional, Developmental, or Behavioral Problem for which they Need/Get Treatment or Counseling
Child CAHPS®: Child's Health Plan, Doctor's Office, or Clinic Helped Get Prescription Medicines for Child
Child CAHPS®: Child's Health Plan, Doctor's Office, or Clinic Helped Get Special Medical Equipment or Devices for Child
Child CAHPS®: Child's Health Plan, Doctor's Office, or Clinic Helped Get Special Therapy for Child
Child CAHPS®: Child's Health Plan, Doctor's Office, or Clinic Helped Get Treatment or Counseling for Child
Child CAHPS®: Child's Personal Doctor Understands How Health Conditions Affect Child's Day-to-Day Life
Child CAHPS®: Child's Personal Doctor Understands How Health Conditions Affect Child's Family's Day-to-Day Life
Child CAHPS®: Customer Service Provided Information or Help: Usually or Always
Child CAHPS®: Customer Service Treated Caregiver with Courtesy and Respect: Usually or Always
Child CAHPS®: Doctor/Other Health Provider Talked About What Caregiver Thought was Best for Child When Discussing Medicine
Child CAHPS®: Doctor/Other Health Provider Talked With Caregiver About Reasons Caregiver Might Want Child to Take Medicine
Child CAHPS®: Doctor/Other Health Provider Talked with Caregiver About Reasons Caregiver Might Not Want Child to Take Medicine
Child CAHPS®: Doctor/Other Health Provider Talked with Caregiver about Specific Things Caregiver Could do to Prevent Illness for Child
Child CAHPS®: Ease In Getting Care, Tests, and Treatment- Usually or Always
Child CAHPS®: Ease in Getting Prescription Medicines for Child - Usually or Always
Child CAHPS®: Ease in Getting Special Medical Equipment or Devices for their Child - Usually or Always
Child CAHPS®: Ease in Getting Special Therapy for their Child - Usually or Always
Child CAHPS®: Ease in Getting Treatment or Counseling for their Child - Usually or Always
Child CAHPS®: Getting Appointment to See Specialist as Soon as Needed: Usually or Always
Child CAHPS®: Getting Needed Care Right Away - Usually or Always
Child CAHPS®: Getting Questions Answered by Child's Doctors or Other Health Providers - Usually or Always
Child CAHPS®: Getting Routine or Check-up Appointments as Soon as They Were Needed: Usually or Always
Child CAHPS®: Got Help Needed From Child's Doctors or Other Health Providers to Contact Child's School or Daycare
Child CAHPS®: Heath Plan Forms Easy to Fill Out: Usually or Always
Child CAHPS®: Needed Child's Doctors or Other Health Providers to Contact Child's School or Daycare
Child CAHPS®: Number of Specialists Seen
A. None
B. One
C. Two
D. Three
E. Four
F. Five or More Specialists
Child CAHPS®: Number of Visits to Personal Doctor
A. None
B. One
C. Two
D. Three
E. Four
F. Five to Nine
G. Ten or More
Child CAHPS®: Personal Doctor Explained Things in a Way That Was Easy for Child to Understand: Usually or Always
Child CAHPS®: Personal Doctor Explained Things in a Way That Was Easy to Understand: Usually or Always
Child CAHPS®: Personal Doctor Listened Carefully: Usually or Always
Child CAHPS®: Personal Doctor Showed Respect: Usually or Always
Child CAHPS®: Personal Doctor Spent Enough time with Child: Usually or Always
Child CAHPS®: Personal Doctor Talked with Caregiver about How Child is Feeling, Growing, or Behaving
Child CAHPS®: Personal Doctor Up-to-Date about Child's Care from other Doctors or Health Providers: Usually or Always
Child CAHPS®: Rating of Health Care - 8, 9 or 10
Child CAHPS®: Rating of Health Plan: 8, 9, or 10
Child CAHPS®: Rating of Overall Health - Very Good or Excellent
Child CAHPS®: Rating of Overall Mental or Emotional Health - Very Good or Excellent
Child CAHPS®: Rating of Personal Doctor - 8, 9 or 10
Child CAHPS®: Rating of Specialist Seen Most Often - 8, 9 or 10
Childhood Immunization Status (CIS, Hybrid Specification): Combination 10
Childhood Immunization Status (CIS, Hybrid Specification): Combination 2
Childhood Immunization Status (CIS, Hybrid Specification): DTaP
Childhood Immunization Status (CIS, Hybrid Specification): Hepatitis A
Childhood Immunization Status (CIS, Hybrid Specification): Hepatitis B
Childhood Immunization Status (CIS, Hybrid Specification): HiB
Childhood Immunization Status (CIS, Hybrid Specification): IPV
Childhood Immunization Status (CIS, Hybrid Specification): Influenza
Childhood Immunization Status (CIS, Hybrid Specification): MMR
Childhood Immunization Status (CIS, Hybrid Specification): PCV
Childhood Immunization Status (CIS, Hybrid Specification): Rotavirus
Childhood Immunization Status (CIS, Hybrid Specification): VZV
Children and Adolescents’ Access to Primary Care Practitioners (CAP): Age 12-19 Years
Children and Adolescents’ Access to Primary Care Practitioners (CAP): Age 12-24 Months
Children and Adolescents’ Access to Primary Care Practitioners (CAP): Age 25 Months - 6 Years
Children and Adolescents’ Access to Primary Care Practitioners (CAP): Age 7-11 Years
Chlamydia Screening in Women (CHL, Administrative Specification)
A. Age 16-20 Years
B. Age 21-24 Years
Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate per 100,000 Enrollee Months (PQI05, CMS Adult Core Set)
A. Age 40-64 Years
B. Age 65 and Older
Claims Quality Assurance: Claims Processing Accuracy
Completion of an Annual Comprehensive Medication Review in Prior Twelve Months for Polypharmacy Members
A. Ages 19-64
B. Ages 65+
Complex Diagnostic Radiology Authorization Timely (2 Day) Determination Rate: Routine Requests
Comprehensive Diabetes Care (CDC, Hybrid Specification): Blood Pressure Controlled <140/90 mm Hg
Comprehensive Diabetes Care (CDC, Hybrid Specification): Eye Exam
Comprehensive Diabetes Care (CDC, Hybrid Specification): HbA1c Control (<7.0%) for a Selected Population
Comprehensive Diabetes Care (CDC, Hybrid Specification): HbA1c Control (<8.0%)
Comprehensive Diabetes Care (CDC, Hybrid Specification): HbA1c Poor Control (>9.0%)
Comprehensive Diabetes Care (CDC, Hybrid Specification): HbA1c Testing
Comprehensive Diabetes Care (CDC, Hybrid Specification): Medical Attention for Nephropathy
Comprehensive Diabetes Care: Hemoglobin A1c Poor Control (>9.0%) (HPC, CMS Adult Core Set)
A. Age 18-64 Years
B. Age 65-75 Years
Comprehensive Diabetes Care: Hemoglobin A1c Testing (HA1C, CMS Adult Core Set)
A. Age 18-64 Years
B. Age 65-75 Years
Comprehensive Diabetes Care: LDL-C Screening (CMS Adult Core Set)
A. Age 18-64 Years
B. Age 65-75 Years
Controlling High Blood Pressure (CBP)
Controlling High Blood Pressure (CBP, CMS Adult Core Set)
A. Age 18-64 Years
B. Age 65-85 Years With & Without a Diagnosis of Diabetes
Developmental Screening in the First Three Years of Life (CMS Child Core Set)
A. Children who turned 1 year of age
B. Children who turned 2 years of age
C. Children who turned 3 years of age
Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)
Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)
Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis (ART)
Elective Delivery (CMS Adult Core Set)
Emergency Department Visits - Potentially Treatable in Primary Care by Age Group - Excluding NHHPP Members
A. Age Less Than 12 Months
B. Age 12-24 Months
C. Age 25 Months-6 Years
D. Age 7-11 Years
E. Age 12-19 Years
F. Age 20-44 Years
G. Age 45-64 Years
H. Age 65 and Older
Emergency Department Visits - Potentially Treatable in Primary Care by Eligibility Group - Excluding NHHPP Members
A. Low-Income Children
B. Children with Severe Disabilities
C. Foster Care, Former Foster Care & Adoption Subsidy
D. Low-Income Non-Elderly Adults & BCCP
E. Adults with Disabilities
F. Elderly & Elderly With Disabilities
Emergency Department Visits - Potentially Treatable in Primary Care by Geographic Region - Excluding NHHPP Members
A. Metropolitan Counties
B. Non-Metropolitan Counties
C. Non-NH/Unknown Counties
Emergency Department Visits by Eligibility Group - Excluding NHHPP Members
A. Low-Income Children
B. Children with Severe Disabilities
C. Foster Care, Former Foster Care & Adoption Subsidy
D. Low-Income Non-Elderly Adults & BCCP
E. Adults with Disabilities
F. Elderly & Elderly With Disabilities
Emergency Department Visits by Geographic Region - Excluding NHHPP Members
A. Metropolitan Counties
B. Non-Metropolitan Counties
C. Non-NH/Unknown Counties
Engagement of Alcohol and Other Drug Dependence Treatment (IET)
A. Age 13 to 17 Years
B. Age 18+ Years
Flu Shots for Adults Ages 50 to 64 (CMS Adult Core Set)
Follow-Up After Hospitalization for Mental Illness (FUH): 30-Day Follow-Up
Follow-Up After Hospitalization for Mental Illness (FUH): 7-Day Follow-Up
Follow-Up After Hospitalization for Mental Illness: Within 30 days of Discharge (CMS Adult Core Set) - Excluding NHHPP Members
A. Age 21-64 Years
B. Age 65 and Older
Follow-Up After Hospitalization for Mental Illness: Within 7 Days of Discharge (CMS Adult Core Set) - Excluding NHHPP Members
A. Age 21-64 Years
B. Age 65 and Older
Follow-Up Care for Children Prescribed ADHD Medication (ADD): Continuation and Maintenance Phase
Follow-Up Care for Children Prescribed ADHD Medication (ADD): Initiation Phase
Frequency of Ongoing Prenatal Care (FPC, Hybrid Specification): 81+ Percent
Grievance Dispositions Made Within 45 Calendar Days
Health Risk Assessment Completion Percentage
Health Risk Assessment Completion for Higher Risk Populations
Health Risk Assessment Quarterly Completions
Heart Failure Admission Rate per 100,000 Enrollee Months (PQI08, CMS Adult Core Set)
A. Age 18-64 Years
B. Age 65 and Older
Human Papillomavirus Vaccine for Female Adolescents (HPV, Hybrid Specification)
Human Papillomavirus Vaccine for Female Adolescents (HPV, Hybrid Specification)
Immunizations for Adolescents (IMA, Hybrid Specification): Combination 1
Immunizations for Adolescents (IMA, Hybrid Specification): Meningococcal Vaccine
Immunizations for Adolescents (IMA, Hybrid Specification): Tdap/Td Vaccine
Initiation & Engagement of Alcohol & Other Drug Dependence Treatment: Engagement (IET, CMS Adult Core Set)
A. Age 18-64 Years
B. Age 65 and Older
Initiation & Engagement of Alcohol & Other Drug Dependence Treatment: Initiation (IET, CMS Adult Core Set)
A. Age 18-64 Years
B. Age 65 and Older
Initiation of Alcohol and Other Drug Dependence Treatment (IET)
A. Age 13 to 17 Years
B. Age 18+ Years
Inpatient Hospital Utilization for Ambulatory Care Sensitive Conditions for Adult Medicaid Members - Annual Rate by Age Group - Excluding NHHPP Members
A. Age 18-44 Years
B. Age 45-64 Years
C. Age 65 and Older
Inpatient Hospital Utilization for Ambulatory Care Sensitive Conditions for Adult Medicaid Members - Quarterly Rate - Excluding NHHPP Members
Interest Paid on Late Paid Claims
Lead Screening in Children (LSC, Administrative Specification)
Lead Screening in Children (LSC, Hybrid Specification)
Maintenance Medication Gaps by Age Group
A. Age 0 to 5 Years
B. Age 6 to 17 Years
C. Age 18 to 64 Years
Medical Assistance with Smoking and Tobacco Use Cessation: Advising Smokers and Tobacco Users to Quit (MSC, CMS Adult Core Set)
A. Age 18-64 Years
Medical Assistance with Smoking and Tobacco Use Cessation: Discussing Cessation Medications (MSC, CMS Adult Core Set)
A. Age 18-64 Years
Medical Assistance with Smoking and Tobacco Use Cessation: Discussing Cessation Strategies (MSC, CMS Adult Core Set)
A. Age 18-64 Years
Medical Service, Equipment and Supply Post Delivery Service Authorization Timely (30 Day) Determination Rate
Medical Service, Equipment and Supply Service Authorization Timely (14 Day) Determination Rate: New Routine Requests
Medical Service, Equipment and Supply Service Authorization Timely Determination Rate: Continued/Extended Urgent Services
Medical Service, Equipment and Supply Service Authorization Timely Determination Rate: Urgent Requests
Medication Management for People With Asthma (MMA): Medication Compliance 50%
A. Age 5 to 11 Years
B. Age 12 to 18 Years
C. Age 19 to 50 Years
D. Age 51 to 64 Years
Medication Management for People With Asthma (MMA): Medication Compliance 75%
A. Age 5 to 11 Years
B. Age 12 to 18 Years
C. Age 19 to 50 Years
D. Age 51 to 64 Years
Member Communications: Calls Abandoned
A. Main Health Plan
B. Pharmacy Benefit Manager (PBM)
C. Non-Emergent Transportation (NEMT) Manager
D. Behavioral Health Manager
E. Vision Manager
Member Communications: New Member Welcome Calls
A. Welcome Call Successfully Completed
B. Call not Successfully Completed with 3 Attempts Made
C. Call Not Successfully Completed With Less Than 3 Attempts Made
D. Insufficient Member Data for Successful Call Completion
E. Call Not Successfully Completed for Other Reason
Member Communications: Reasons for Telephone Inquiries
A. Benefit Question Non-RX
B. Rx-Question
C. Billing Issue
D. Finding / Changing a PCP
E. Finding a Specialist
F. Complaints About Health Plan
G. Enrollment Status
H. Material Request
I. Information / Demographic Update
J. Giveaways
K. Other
L. NEMT Inquiry
Member Communications: Speed to Answer Within 30 Seconds
A. Main Health Plan
B. Pharmacy Benefit Manager (PBM)
C. Non-Emergent Transportation (NEMT) Manager
D. Behavioral Health Manager
E. Vision Manager
Member Communications: Voice Mails Returned by Next Business Day
A. Main Health Plan
D. Behavioral Health Manager
Member Communications: Warm Transfers to NH DHHS
A. DHHS Temporary Medicaid Call Center
B. DHHS Medicaid Call Center
C. DHHS Central Processing Unit
D. DHHS Other
Member Communications: New Members Who Had a Successfully Completed New Member Welcome Call or Received at Least Three Welcome Call Attempts
Member NEMT Grievance Dispositions Resolved Within 30 Calendar Days
Member NEMT Grievances
Member Requests for Assistance Accessing MCO Designated Primary Care Providers per Average Members by County
A. Belknap County
B. Carroll County
C. Cheshire County
D. Coos County
E. Grafton County
F. Hillsborough County
G. Merrimack County
H. Rockingham County
I. Strafford County
J. Sullivan County
K. Non-NH/Unknown Counties
Member Requests for Assistance Accessing MCO Designated Primary Care Providers per Average Members by Geographic Region - Excluding NHHPP Members
A. Metropolitan Counties
B. Non-Metropolitan Counties
C. Non-New Hampshire/Unknown Counties
Member Requests for Assistance Accessing Other Providers (non-Physician/APRN) per Average Members by County
A. Belknap County
B. Carroll County
C. Cheshire County
D. Coos County
E. Grafton County
F. Hillsborough County
G. Merrimack County
H. Rockingham County
I. Strafford County
J. Sullivan County
K. Non-NH/Unknown Counties
Member Requests for Assistance Accessing Other Providers (non-Physician/APRN) per Average Members by Geographic Region - Excluding NHHPP Members
A. Metropolitan Counties
B. Non-Metropolitan Counties
C. Non-NH/Unknown Counties
Member Requests for Assistance Accessing Physician/APRN Specialists (non-MCO Designated Primary Care) Providers per Average Members by County
A. Belknap County
B. Carroll County
C. Cheshire County
D. Coos County
E. Grafton County
F. Hillsborough County
G. Merrimack County
H. Rockingham County
I. Strafford County
J. Sullivan County
K. Non-NH/Unknown Counties
Member Requests for Assistance Accessing Physician/APRN Specialists (non-MCO Designated Primary Care) Providers per Average Members by Geographic Region - Excluding NHHPP Members
A. Metropolitan Counties
B. Non-Metropolitan Counties
C. Non-NH/Unknown Counties
Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
A. Age 1-5 Years
B. Age 6-11 Years
C. Age 12-17 Years
NEMT Timely Claims Processing
NH Hospital Discharges - Discharge Plan Provided to Aftercare Provider Within 7 Calendar Days of Member Discharge
NH Hospital Discharges - Member Had a Follow up Appointment Scheduled for Within 7 Calendar Days of Discharge
NH Hospital Discharges - Member Received Discharge Instruction Sheet
NH Hospital Discharges - New CMHC Patient Had an Intake Appointment with a CMHC Within 7 Calendar Days of Discharge
NH Hospital Discharges - Unsuccessful in Contacting Members within 3 Business Days of Discharge - By Reason
A: The Plan Failed to Make an Attempt to Contact Member
B. Insufficient Data for Successful Contact: Plan Outreached To Member's Providers for Contact Information
C. Insufficient Data for Successful Contact: Plan Did Not Outreach To Member's Providers for Contact Information
D. Member Did Not Answer Call
E. Member Refused to Communicate with Plan
F. Discharged to Location where Unreachable
G. Member Contacted After Three Days
H. Other Reason
New Hampshire Hospital Discharges - MCO Contacts and Contact Attempts
New Member Health Needs Assessment - MCO Successfully Completed HNA
A. Within 30 Days for Pregnant Women, and Adults/Children with Special Health Care Needs
B. Within 90 Days for All Other Members
New Member Health Needs Assessment – Best Effort to Conduct a Health Needs Assessment
A. Within 30 Days for Pregnant Women, and Adults/Children with Special Health Care Needs
B. Within 90 Days for All Other Members
Non-Emergent Transportation - Contracted Transportation & Wheelchair Van Provider Scheduled Trips (Excluding Rides for Methadone Treatment) - Timeliness
A. Delivered On-Time
B. Delivered Late
Non-Emergent Transportation Calls That Were Abandoned
Non-Emergent Transportation Contracted Transportation & Wheelchair Van Provider Scheduled Trip Member Cancellations by Reason for Member Cancellation for Contracted Providers
A. Appointment changed or cancelled
B. Member Found Other Transportation
C. Member Illness
D. Other Reason
Non-Emergent Transportation Contracted Transportation & Wheelchair Van Provider Scheduled Trip Results by Outcome
A. Member Cancelled or Rescheduled
B. Transportation Provider Cancelled or Rescheduled
C. Member No Show
D. Transportation Provider No Show
E. Other Reason Trip Wasn't Made
F. Delivered
G. Unknown if Trip Occurred
Non-Emergent Transportation Contracted Transportation & Wheelchair Van Provider Scheduled Trip Results by Outcome - Excluding NHHPP Members
A. Member Cancelled or Rescheduled
B. Transportation Provider Cancelled or Rescheduled
C. Member No Show
D. Transportation Provider No Show
E. Other Reason Trip Wasn't Made
F. Delivered
G. Delivered-On Time
H. Delivered-Late
I. Delivered-Unknown If On Time Or Late
J. Unknown if Trip Occurred
Non-Emergent Transportation Request Authorization Approval Rate by Mode of Transportation
A. Contracted Transportation Provider (Non-Wheelchair Van)
B. Volunteer Driver
C. Member
D. Public Transportation
E. Wheelchair Van
F. Other
Non-Emergent Transportation Requests Delivered by Mode of Transportation
A. Contracted Transportation Provider (Non-Wheelchair Van)
B. Volunteer Driver
C. Member
D. Public Transportation
E. Wheelchair Van
F. Other
Non-Emergent Transportation Requests Delivered by Type of Medical Service
A. Hospital
B. Medical Provider
C. Mental Health Provider
D. Dentist
E. Pharmacy
F. Methadone Treatment
G. Other
Non-Emergent Transportation Speed to Answer Within 30 Seconds
Non-Emergent Transportation Speed to Answer Within 90 Seconds
Non-Emergent Transportation Voice Mails Returned by Next Business Day
Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS)
Persistence of Beta-Blocker Treatment After a Heart Attack (PBH)
Pharmacotherapy Management of COPD Exacerbation (PCE): Bronchodilator
Pharmacotherapy Management of COPD Exacerbation (PCE): Systemic Corticosteroid
Pharmacy Prior Authorizations Requests By Behavioral Health and Non-Behavioral Health Therapeutic Drug Classes
Pharmacy Prior Authorizations Requests By Select Therapeutic Drug Class and Outcome: A. Behavioral Health Medications
A-1: Approved
A-2: Denied
A-3: Pending
Pharmacy Prior Authorizations Requests By Select Therapeutic Drug Class and Outcome: B. Non-Behavioral Health Medications
B-1: Approved
B-2: Denied
B-3: Pending
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
Physician/APRN/Clinic Visits by Age Group - Excluding NHHPP Members
A. Age Less Than 12 Months
B. Age 12-24 Months
C. Age 25 months-6 years
D. Age 7-11 Years
E. Age 12-19 Years
F. Age 20-44 Years
G. Age 45-64 Years
H. Age 65 and Older
Physician/APRN/Clinic Visits by Eligibility Group - Excluding NHHPP Members
A. Low-Income Children
B. Children With Severe Disabilities
C. Foster Care, Former Foster Care & Adoption Subsidy
D. Low-Income Non-Elderly Adults & BCCP
E. Adults with Disabilities
F. Elderly & Elderly With Disabilities
Physician/APRN/Clinic Visits by Geographic Regions - Excluding NHHPP Members
A. Metropolitan Counties
B. Non-Metropolitan Counties
C. Non-NH/Unknown Counties
Prenatal and Postpartum Care (PPC, Hybrid Specification): Postpartum Care
Prenatal and Postpartum Care (PPC, Hybrid Specification): Timeliness of Prenatal Care
Prenatal and Postpartum Care: Postpartum Care Rate (CMS Adult Core Set) - Excluding NHHPP Members
Private Duty Nursing: Authorized Hours for Adults Delivered and Billed by Month
A. Day/Evening Hours
B. Night/Weekend Hours
C. Intensive Care (Ventilator Dependent) Hours
D. Unbilled Hours
Private Duty Nursing: Authorized Hours for Children Delivered and Billed by Month
A. Day/Evening Hours
B. Night/Weekend Hours
C. Intensive Care (Ventilator Dependent) Hours
D. Unbilled Hours
Professional and Facility Medical Claim Processing Results
A. Paid
B. Suspended
C. Denied
Provider Communications: Calls Abandoned
A. Main Health Plan
B. Pharmacy Benefit Manager (PBM)
C. Non-Emergent Transportation (NEMT) Manager
D. Behavioral Health Manager
E. Vision Manager
Provider Communications: Mean Call Time
A. Main Health Plan
B. Pharmacy Benefit Manager (PBM)
C. Non-Emergent Transportation (NEMT) Manager.
D. Behavioral Health Manager
E. Vision Manager
Provider Communications: Speed to Answer Within 30 Seconds
A. Main Health Plan
B. Pharmacy Benefit Manager (PBM)
C. Non-Emergent Transportation (NEMT) Manager
D. Behavioral Health Manager
E. Vision Manager
Provider Communications: Reasons for Telephone Inquiries
A. Verifying Member Eligibility
B. Billing/Payment
C. Service Authorization
D. Change of Address, Name, Contact Info., etc.
E. Changing Service Mix Offered by Provider
F. Changing Panel Size
G. Voluntary Termination
H. Enrollment/Credentialing
I. Complaints About Health Plan
J. Other
Provider Communications: Voice Mails Returned by Next Business Day
A. Main Health Plan
Quality Assessment: Referral to Case Management for All Newborns With a Diagnosis of Neonatal Abstinence Syndrome
Resolution of All Appeals Within 45 Calendar Days
Resolution of Appeals by Disposition Type
A. Member Abandoned Appeal
B. Appeal Upheld
C. Appeal Reversed
Resolution of Expedited Appeals Within 3 Calendar Days
Resolution of Extended Standard Appeals Within 44 Calendar Days
Resolution of Standard Appeals Within 30 Calendar Days
Safety Monitoring - Opioid Prescriptions Meeting NH DHHS Morphine Equivalent Dosage Prior Authorization Compliance
Safety Monitoring - Use of at Least One High-Risk Medication in the Elderly, Excluding Medicare/Medicaid Dual Enrollees
Safety Monitoring - Use of at Least Two High-Risk Medications in the Elderly, Excluding Medicare/Medicaid Dual Enrollees
Screening For Clinical Depression And Follow-Up Plan (CDF, CMS Adult Core Set)
A. Age 18 to 64 Years
B. Age 65 and Older
Statin Therapy for Patients With Cardiovascular Disease (SPC): Received Statin Therapy
A. Males Age 21 to 75
B. Females Age 40 to 75
Statin Therapy for Patients With Cardiovascular Disease (SPC): Statin Adherence 80%
A. Males Age 21 to 75
B. Females Age 40 to 75
Statin Therapy for Patients With Diabetes Disease (SPD): Received Statin Therapy
Statin Therapy for Patients With Diabetes Disease (SPD): Statin Adherence 80%
Timeliness of Notice Delivery: Expedited Process
Timeliness of Notice Delivery: Standard Service Authorization Denial
Timeliness of Notice Delivery: Standard Service Authorization Denial With Extension
Timely Pharmacy Claim Processing
Timely Professional and Facility Medical Claim Processing
Timely Professional and Facility Medical Claim Processing: Sixty Days of Receipt
Timely Transmission of Transition Record from Inpatient Facility to Other Site of Care (CTR, CMS Adult Core Set)
A. Age 18-64 Years
B. Age 65 and Older
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP)
A. Age 1-5 Years
B. Age 6-11 Years
C. Age 12-17 Years
Use of Imaging Studies for Low Back Pain (LBP)
Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC)
A. Age 1-5 Years
B. Age 6-11 Years
C. Age 12-17 Years
Use of Opioids at High Dosage (OHD, CMS Adult Core Set)
A. Age 19 to 64 Years
B. Age 65 and Older
Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC, Hybrid Specification): Counseling for Nutrition
A. Age 3-11 Years
B. Age 12-17 Years
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC, Hybrid Specification): Counseling for Physical Activity
A. Age 3-11 Years
B. Age 12-17 Years
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC, Hybrid Specification): Evidence of BMI Percentile Documentation
A. Age 3-11 Years
B. Age 12-17 Years
Well-Child Visits in the First 15 Months of Life (W15, Hybrid Specification): 6 or More Visits
Well-Child Visits in the First 15 Months of Life for 6 or More Visits by Geographic Region - Excluding NHHPP Members
A. Metropolitan Counties
B. Non-Metropolitan Counties
C. Non-NH/Unknown Counties
Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34, Hybrid Specification)
Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life by Geographic Region - Excluding NHHPP Members
A. Metropolitan Counties
B. Non-Metropolitan Counties
C. Non-NH/Unknown Counties
Medical Assistance with Smoking and Tobacco Use Cessation: Advising Smokers and Tobacco Users to Quit (CMS Adult Core Set): B. Age 65 and Older
Medical Assistance with Smoking and Tobacco Use Cessation: Discussing Cessation Medications (CMS Adult Core Set): B. Age 65 and Older
Medical Assistance with Smoking and Tobacco Use Cessation: Discussing Cessation Strategies (CMS Adult Core Set): B. Age 65 and Older
Member Communications: Voice Mails Returned by Next Business Day: B. Pharmacy Benefit Manager (PBM)
Provider Communications: Voice Mails Returned by Next Business Day: B. Pharmacy Benefit Manager (PBM)
Provider Communications: Voice Mails Returned by Next Business Day: D. Behavioral Health Manager
Provider Communications: Voice Mails Returned by Next Business Day: E. Vision Manager
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