Our Quality Management Plan is based upon NCQA-sponsored Health Effectiveness Data and Information Set (HEDIS®).
In addition, our Quality Management Plan is evaluated on a calendar year basis. An annual review is completed, following the close of the previous year and is reviewed for effectiveness throughout the year.
At the staff level, we conduct call monitoring and record review on all staff. The frequency and intensity of the call monitoring is based on established policy and procedures. In addition, random monitoring occurs by the quality team to validate supervisory assessments and to ensure inter-rater reliability.
At the program level, due diligence visits from regulators and accrediting bodies are performed and encouraged.
Lastly, we engage an unbiased external medical review panel to test the clinical rigor of our guidelines and logic on an annual basis.