In early 2008, the Centers for Medicare & Medicaid Services (CMS) contracted with the National Committee for Quality Assurance (NCQA) to develop a strategy to evaluate the quality of care provided by Medicare Advantage Special Needs Plans (SNPs). This strategy relies on a phased approach, beginning with defining and assessing desirable structural characteristics and followed by assessing processes and, eventually, outcomes. The evaluation approach includes several types of assessments.
The State of Wisconsin has a similar program to CMS to evaluate the quality of care provided by Medicaid Plans. The goal of this program is to improve the quality of care received by BadgerCare Plus and Medicaid SSI members. The Pay-for-Performance (P4P) Program uses HEDIS specifications for all of the P4P measures. MY2021 baselines for HEDIS measures are set using the latest available MY2019 HEDIS state-wide averages and the MY2019 national HEDIS percentiles as published in the Quality Compass.
iCare successfully completed the NCQA-Certified HEDIS® Compliance Audit™ for Medicaid and Medicare.
NCQA is a private, non-profit organization dedicated to improving health care quality.
The documents below show the current quality measures for CMS Five Star Quality Program for Medicare Advantage Plans and the Medicaid Pay-for-Performance Plans.
MY2021 CMS Part C and Part D 5-Star Rating Measures
MY2021 SSI Medicaid and BC+ P4P Measures Overview
...that iCare conducts Provider Satisfaction Surveys?
Show me the Results
As part of Independent Care Health Plan ’s contract with The Centers for Medicare & Medicaid Services (CMS), it is required to compile and report diagnostic profiles annually. This information must be obtained via a medical record review of individual member diagnoses that were treated or impacted within a claim (calendar) year.
Independent Care Health Plan has partnered with Cognisight to perform the annual collection of data and confirmation project. Cognisight’s goal is to obtain a “complete diagnostic member profile,” while attempting to minimize disruptions to your office workflow and staff.
CMS will only accept submission of diagnoses when they are listed on an encounter note rather than on an active problem list, signed lab result or consult. This does not imply that a provider’s documentation for the purposes of patient care is not sufficient, only that CMS has specific requirements to recognize existing diagnoses for a patient.
This information is time-sensitive and a response is needed as soon as possible.
If you have additional questions, please contact Mark Clausen, Cognisight Account Manager at 585-662-4290 or Amanda Harcus, iCare Director of Financial Data Analytics at aharcus@iCareHealthPlan.org.
Medicare Star Ratings
Care Management
Claims Processing
Clinical Practice Guidelines Policy
Compliance Information
Direct Care Workplace Provider Agreement Template
Drug Coverage Information
Electronic Claims Submission
iCare Provider Portal
iCare Quality Improvement Program Policy QI-012
iCare Quality Improvement Program Oversight Policy QI-013
Provider Forms & Pubs
H2237_IC2203_M Last Updated 6/29/21
Leaving iCareHealthPlan.org
By clicking this link, you may be leaving the iCareHealthPlan.org website. Independent Care Health Plan (iCare) only provides these links and pointers for your information and convenience. When you select a link to an outside website, you are leaving the www.iCareHealthPlan.org website.
ProceedCancel