Billing Manual for Community Care Network Providers

I.C.2 MeasurementExplicit, well-defined critical performance measures are the essential component ofCommunity Care's quality management program. Critical performance indicatorsrepresent what is most important to Community Care in defining quality. They aredeveloped using sound methodological principles. The performance data that resultfrom measurement are reliable so that decisions can be made with confidence.Measurements are specifically defined in Community Care’s quality assurance WorkPlans. Each topic includes the measurements, goals, and timing of each activity. On anannual basis, Community Care publishes the results of Work Plan monitoring activitiesand studies in our communications. Interventions and results are also described.I.C.3 Record ReviewCertain measurements in Community Care’s annual Quality Management Work Planrely upon data collection through confidential record review. Selected network providersare contacted in advance of a record review. Areas of focus include topics such asaccessibility to covered services, appointment availability, coordination of care, qualityof care, and record keeping. Community Care expects providers to agree to furnishpertinent sections of an enrollee’s medical records, consistent with appropriate rules ofconfidentiality for patient records as described in the Network Provider Agreement andas specifically required by HealthChoices.I.C.4 Quality Management Program StructureThe quality management program description describes the structure and processes ofthe quality management program. The Work Plan lists the activities that comprise thequality management program. The Quality and Care Management Committee (QCMC)oversees implementation of the program and Work Plan.The quality management program is designed to continuously improve performance andprovide members with high-quality, cost-effective healthcare services, access andavailability to culturally competent healthcare providers and services, continuity andcoordination of care across all heath care delivery settings, and effective behavioralhealth prevention programs and health education services.I.C.5 Availability StandardsCommunity Care monitors availability by category of service, through its GeoAccessreporting capabilities, to ensure access to a Provider:Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 20