Provider Quality

We appreciate your commitment to serving our special needs population. To help you focus on providing the best possible care to your patients, we’ve compiled our quality materials all in one place. If you have questions or suggestions, please contact us.

Provider Relations phone: 1-800-424-4495
Provider Relations email: MCCVAProvider@MagellanHealth.com

If you suspect possible fraud, waste or abuse, please report it on the Molina Alert Line:

By phone: 1-866-606-3889

Online: https://molinahealthcare.alertline.com

MCC of VA (HMO SNP)’s Quality Improvement Program (QIP) 

QIP is designed to measure, assess and improve the quality of care and quality of service we provideour members. Our program includes steps to ensure member safety, manage their complex healthcare issues, and meet their diverse cultural and linguistic needs.

Quality improvement activities focus on member satisfaction, complaints and appeals, contract services and credentialing, clinical services, utilization management and clinical program initiatives, outreach activities, education and reporting compliance. We annually select specific quality improvement initiatives for implementation and evaluation at year’s end.

For more information, please contact Member Services at 1-800-424-4495 (TTY 711).

HEDIS® Measures of Focus

Each year, performance measures are developed and maintained by the National Committee for Quality Assurance (NCQA). These performance measures are critical in the accreditation process for healthcare providers.

As an MCC of VA (HMO SNP) provider, you play a major part in helping us achieve and report on these quality of care measures for our members—beginning with services you provide, extending to the way you code them and finishing with your support during chart reviews.

The Healthcare Effectiveness Data and Information Set (HEDIS®) allows consumers to compare health plan performance to other plans and to national or regional benchmarks. HEDIS® results are used to track year-to-year performance. The HEDIS® measures are divided into six (6) “domains of care:”

Effectiveness of Care
Access/Availability of Care
Experience of Care
Utilization and Risk Adjusted Utilization
Health Plan Descriptive Information
Measures Collected Using Electronic Clinical Data Systems

HEDIS® data is collected through surveys, medical charts and insurance claims for hospitalizations, medical office visits, procedures and pharmacy services.

There are some HEDIS® measures that are based upon administrative (claims) data. To support these measures, it is important that providers use appropriate, up-to-date diagnosis and procedure codes to assure that services are accurately captured. You can find the HEDIS® Measures of Focus Guide here; download it to learn more about the importance of participation and accurate reporting of measures achieved.

Also available is the recently published HEDIS® Telehealth Codes Reference Guidewhich includes program codes for telehealth services you might provide. Click the link above to download it.

The Medicare Star Ratings Program

This Medicare quality program rates all health and prescription drug plans each year, based on a plan’s quality and performance. Download this document to learn more about the program.