Care Management Program
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Care Coordination | Care Management | Grievances and Appeals | Health Services Management - Standard Medicaid | HEDIS Acute and Chronic Care Measures | HEDIS Behavioral Health Care Measures | HEDIS Preventive Care Measures | Member Experience of Care - Children | Member Services | Network Adequacy | Non-Emergent Medical Transportation (NEMT) | Provider Services▲ Back to top
Care Coordination
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Care Management
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Grievances and Appeals
- Member Appeals Received
- Member Grievances Received
- Resolution of All Appeals within 45 Calendar Days
- Resolution of Appeals by Disposition Type
- Resolution of Expedited Appeals within 72 Hours
- Resolution of Extended Standard Appeals within 44 Calendar Days
- Resolution of Provider Appeals within 30 Calendar Days
- Resolution of Standard Appeals within 30 Calendar Days
- Services Authorized within 72 Hours Following a Reversed Appeal
- Timely Processing of Grievances
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Health Services Management - Standard Medicaid
- 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
- Pharmacy Service Authorization Timely Determination Rate
- Service Authorization Denials for Waiver & Non-HCBC Waiver Populations
- Service Authorizations: Physical, Occupational & Speech Therapy Service Authorization Denials by Waiver & Non-HCBC Waiver Populations
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HEDIS Acute and Chronic Care Measures
- Blood Pressure Control (<140/90) (BPD)
- Comprehensive Diabetes Care (CDC, Hybrid Specification): Medical Attention for Nephropathy
- Eye Exam for Patients With Diabetes (EED)
- Hemoglobin A1c Control for Patients with Diabetes: HbA1c Poor Control (>9.0%) (HBD)
- Kidney Health Evaluation for Patients With Diabetes (KED)
- Lead Screening (LSC)
- Medication Management for People With Asthma (MMA): Medication Compliance 50%
- Medication Management for People With Asthma (MMA): Medication Compliance 75%
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HEDIS Behavioral Health Care Measures
- 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
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HEDIS Preventive Care Measures
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Member Experience of Care - Children
- 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® - Child)
- Number of Specialists Child Talked To (CAHPS® - Child)
- Number of Visits with Personal Doctor (CAHPS® - Child)
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Member Services
- Family and Friends Program NEMT Legs
- 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
- NEMT Legs Delivered by Covered Medical Service
- NEMT Request Authorization Approvals by Mode of Transportation
- Requests for Assistance Accessing MCO Designated Primary Care Providers by County
- Requests for Assistance Accessing non-MCO Designated Physician/APRN Specialists by County
- Results of Scheduled NEMT Legs by Outcome
- Timeliness of Scheduled and Delivered NEMT Legs
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Network Adequacy
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Non-Emergent Medical Transportation (NEMT)
- Family and Friends Program NEMT Legs
- NEMT Legs Delivered by Covered Medical Service
- NEMT Request Authorization Approvals by Mode of Transportation
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Provider Services
- Average Pharmacy Claim Processing Time
- NEMT Claims Quality Assurance: Claims Processing Accuracy
- NEMT Timely Claims Processing
- Professional and Facility Medical Claim Processing Results
- 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
- 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 Electronic Provider Claims: Fifteen Days of Receipt
- Timely Processing of Non-Electronic Provider Claims: Thirty Days of Receipt