Quality (HEDIS)

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HEDIS® (Healthcare Effectiveness Data and Information Set) is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA) to objectively measure, report, and compare quality across health plans. NCQA develops HEDIS® measures through a committee represented by purchasers, consumers, health plans, health care providers, and policy makers.

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Referral Management

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Referral is the process of sending a patient to another practitioner (ex. specialist) for consultation or a health care service that the referring source believes is necessary but is not prepared or qualified to provide.

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Credentialing

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Recording information about the services provided into a medical claim for billing. Without ACCURATE documentation of clinical care services, revenue could be lost because charges are incorrect or aren’t made at all.

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CDI/Chart Prep

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Ensuring\that the events of the patient encounter are captured accurately, and the electronic health records properly reflects the services that were provided.

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