Quality Improvement Resources

Welcome to our Quality Improvement Resources! At Aetna Better Health of Pennsylvania, we value our provider partners. We want to make it easy for you to care for our members and guide them down the path to better health.

To achieve this goal we have developed the Quality Improvement Resources. This resource will benefit you in the following ways:

  • Help improve HEDIS Ratings, Pay for Quality Scores, and incentive payments
  • Provide coding tips from the National Committee for Quality Assurance (NCQA)
  • Allow easy access to important provider documents and tools.

 

Adherence to Antipsychotic Medications for Individuals with Schizophrenia

Adolescent Well Care

Adult BMI Assessment

Access and Availability of Care

Ambulatory Care (AMB)

Annual Dental Visit

Antidepressant Medication Management

Appropriate Testing for Children with Pharyngitis

Appropriate Treatment for Children with Upper Respiratory Infection

Asthma Medication Ratio (AMR)

Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis

Breast Cancer Screening

Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia

Cervical Cancer Screening

Childhood Immunization Status

Chlamydia Screening in Women

Comprehensive Diabetes Care

Controlling High Blood Pressure

Diabetes Monitoring for People with Diabetes and Schizophrenia

Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications

Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid

Follow-Up After Hospitalization for Mental Illness (FUH)

Follow-Up Care for Children Prescribed ADHD Medication

Immunizations for Adolescents

Lead Screening in Children

Maternity measures; Frequency of Ongoing Prenatal Care and Prenatal and Postpartum Care

Medication Management for People With Asthma

Metabolic Monitoring for Children and Adolescents on Antipsychotics

Persistence of Beta-Blocker Treatment After a Heart Attack (PBH)

Pharmacotherapy Management of COPD Exacerbation

Plan All Cause Readmission - PCR2020

Reducing Potentially Preventable Readmissions (RPR)

Statin Therapy for Patients With Cardiovascular Disease (SPC)

Statin Therapy for Patients With Diabetes (SPD)

Use of Imaging Studies for Low Back Pain (LBP)

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents

Well-child visits in the first 15 months of life

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life

 

 

Practitioner Information Change Form

When you need to update information for you practice, i.e. adding a new PCP to your roster, this form needs filled out and sent in to the plan.

Provider Secure Web Portal Registration Form

Register for this portal to access claims information, member panels, additional forms, the Provider Report Management Tool, and much more!

Member Care Information Portal Registration Form

Register for this portal to electronically upload Obstetrical Needs Assessment Forms (ONAFs). Incentives are tied to electronic uploads in the P4Q Program.

Patient Record of Care Form

Provide this form to members that may be attending screening events where codes are not submitted. This signed form can be added to the patient's record and count towards your HEDIS scores!

Case Management Special Needs Referral Fillable Form

HEDIS Measures Overview reference guide 

Provider Portal Quick Tips

This guide walks you through utilization of the secure web portal

Member Care Information Portal Guide

Learn how to upload ONAFs electronically to the Member Care Information Portal

Provider Report Management Tool Overview and Navigation

Learn how to access this tool where you can pull Quality Reports such as HEDIS Gaps in Care

Provider Pay for Quality (P4Q) Tip Sheet

You may be eligible to earn more compensation with our Pay for Quality (P4Q) program! Refer to this tip sheet for information on the program, eligibility, and incentives

Understanding Social Determinants of Health ICD-10 Codes

Community Health Workers Maternity Program Overview

View past webinars to learn how you can improve HEDIS rates and member health outcomes.

For a complete listing of all offerings in 2019 click here.