Quality
The Quality Improvement (QI) Program monitors and evaluates the quality, appropriateness, accessibility and availability of health care services.
HEDIS®
HEDIS® is a tool used by more than 90% of America’s health plans to measure performance on important dimensions of care and service. The tool is comprised of 80 measures across five domains of care, including:
- Effectiveness of care
- Access and availability of care
- Experience of care
- Utilization and Relative Resource Use
- Health Plan Descriptive Information
HEDIS® is a mandatory process that occurs annually. We've developed this toolkit to help identify required preventive services.
HEDIS® Measurement Year 2023 Toolkit
HEDIS® Measurement Year 2022 Toolkit
Helpful Information
View Clinical Guidelines
Clinical Coverage Guidelines
Evidence-based guidelines detailing the medical necessity of procedures or technologies.
NJ FamilyCare Dental Services Clinical Criteria
Clinical Practice Guidelines
CPGs outline medical standards of care and best practices.
Additional Resources
Dental Providers can access the additional resources for dental care including the NJ FamilyCare Dental Services Clinical Criteria Policy by visiting the Liberty Dental Plan website.
QI may conduct annual medical record audits in physician offices. Patient records are reviewed for evidence that care and screenings have been documented.
Network providers are contractually required to cooperate with quality improvement activities. Providers are also invited to volunteer for the QI Program. Please contact us if you’re interested in volunteering.