Search results
Results from the WOW.Com Content Network
The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks.
Health plans seek accreditation and measure performance through the administration and submission of the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. The National Committee for Quality Assurance provides an evidence-based program for case-management ...
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
Odyssey entered into a “corporate integrity agreement” with the federal government and installed a “first of its kind clinical review protocol” to ensure that such abuses did not happen again, the company said in a press release. “We are pleased to have permanently resolved these matters with the federal government,” Odyssey said.
These criteria, in order to avoid paper charts reviews are in most cases based on insurance claims. For example, for diabetes, HEDIS selects an eligible population based on age (18–75 years), continuous enrollment with a certain health insurer and certain "Events/diagnosis" from pharmacy data (electronic), insurance claims data (electronic ...
Get AOL Mail for FREE! Manage your email like never before with travel, photo & document views. Personalize your inbox with themes & tabs. You've Got Mail!
“Silent reviews” help TikTok users create content without words. Such nonverbal communication can bring interest and excitement into online conversations. Words are overrated.
Drinking coffee could extend your life up to two years, new research finds. Regular coffee consumption was found to be associated with increased health span (time spent living free from serious ...