Quality improvement

The resources you need to ensure performance and quality of care

Our goal is to supply you with information that will help you treat your patients so they can achieve whole-person health.

The following quality improvement resources provide guidance on evidence-based care and will assist with adherence to state and federal regulations.

Ensuring the quality of care through documentation

Proper documentation is necessary to ensure the safety of the person and the continuity of care. Documentation requirements are a contractual obligation for all our providers. With our treatment record review tool, we can evaluate provider quality and compliance.

Click on the following links to access tip sheets, FAQs, and training to remain compliant with our documentation requirements.

Medicare opioid treatment programs

Access the presentation 

HEDIS1 Provider Guide and Toolkit

The National Committee for Quality Assurance (NCQA) develops and maintains a set of performance measures in the managed care industry referred to as Healthcare Effectiveness Data Information Set (HEDIS).  These measures allow consumers to compare health plan performance to national or regional benchmarks.

 

Several HEDIS measures relate to behavioral health and assist providers with improving member outcomes. We have created the HEDIS provider toolkit with educational materials and additional resources to guarantee your success.

Additional resources2

Learn more about the clinical practice guidelines we have adopted per standards specified by the American Medical Association and the National Academy of Medicine.

Our Corporate Quality Medical Management Committee (CQMMC) adopts, reviews, revises, and approves medical necessity criteria per client and regulatory requirements. Use this guide to help determine what criteria pertain to you and your patients.

Our provider toolkit aims to help identify and determine next steps in treatment for behavioral health conditions so we can achieve positive patient outcomes together.

Access the provider toolkit

Questions? We're here to help.

Whether you have a question or are interested in learning more about how we can best support you, please call our National Provider Services Line at 800-397-1630, Monday to Friday, 8 a.m. to 8 p.m. Eastern time.

Join the Carelon Behavioral Health provider network

Please submit an application today to get started.

1 HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
2 Today, we are Carelon Behavioral Health, but when we created these materials, we were Beacon Health Options.