The standards, provide a framework for implementing best practices to improve:
- Quality Management and Improvement: Monitor, evaluate and improve the quality and safety of care.
- Care Coordination: Coordinate medical care and behavioral healthcare for its members.
- Utilization Management: Notifies members and practitioners about coverage decisions within required time frames.
- Credentialing and Recredentialing: Verifies the credentials of the practitioners in its network.
- Members’ Rights and Responsibilities: Written members’ rights and responsibilities policy exist.
To see the program requirement details, get the Standards & Guidelines document.
ALL 2019