Quality management
Amerigroup Community Care maintains a comprehensive Quality Management (QM) program to objectively monitor and systematically evaluate the care and service provided to members. The scope and content of the program reflects the demographic and epidemiological needs of the population served. Studies are planned across the continuum of care and service, with ongoing proactive evaluation and refinement of the program.
Related information
The Healthcare Effectiveness Data and Information Set (HEDIS®)
Medicare Advantage Medical Record Documentation and Coding Tips
Documents
- HEDIS Desktop Reference Guide 2022
- Medicare Advantage – Clinical HEDIS Medicare Stars Quick Reference Guide
- Medical Record Review Audit Tool
- Medical Record Review Audit Guide
- HEDIS Desktop Reference Guide for Medicaid Providers
- HEDIS Benchmarks and Coding Guidelines
- Clinical Practice Guidelines Matrix
- Cognitive Care Program
HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization lookup tool
- Prior Authorization requirements
- Claims overview
- Member eligibility & pharmacy overview
- Provider manual and guides
- Referrals
- Forms
- Training Academy
- Pharmacy information
- Electronic Data Interchange (EDI)