Welcome to Provider's Corner! This section of our website is customized to meet your needs and will include useful tips and ideas for practices and procedures you need to complete for NCQA, Buckeye and Ohio Department of Medicaid requirements. The intent is to create an easy-to-use, one-stop shop with helpful specifics around Quality measures, such as HEDIS, CAHPS and clinical processes you can use to meet the criteria for these requirements. Be sure to bookmark this page to make it easy to return when you need to reference content. We hope you find this helpful and are open to topics you’d like discussed on the site.
We’re excited to introduce the Provider Planner that includes an unbranded Patient Pre-Visit Checklist and Clinical Follow-Up Form, designed to improve care coordination and enhance patient experience.
What’s included:
- Pre-Visit Checklist: Captures key patient information such as recent specialist visits, hospitalizations, medication concerns, preventive care, and social/emotional well-being.
- Clinical Follow-Up: Provides clear instructions for rooming staff to address flagged responses, gather additional details, and complete follow-up actions.
How to use:
- Review flagged responses during rooming.
- Obtain additional information and complete the appropriate sections.
- Report findings promptly to the provider for timely interventions.
Unbranded Video for Waiting Rooms: Making Every Visit Count
We’re excited to share a new unbranded video that can be played in provider office waiting rooms. The video emphasizes our commitment to patient health and comfort at every visit and encourages open conversations about:
- Balance and mobility
- Mood and mental health
- Pain, fatigue, or anything that feels “off”
- Bladder health
- Memory changes
- Preventive care and medications
Your patients matter—ALWAYS. This video helps remind them that their questions are welcome and their care is a partnership.
These tools help streamline communication, close care gaps, and empower patients with education and resources. The Provider Planner introduces a Pre‑Visit Checklist and Clinical Follow‑Up Form to improve care coordination, along with an unbranded waiting‑room video that encourages open conversations about key health concerns.
Together, these tools support stronger communication, close care gaps, and enhance the overall patient experience.
- The Consumer Assessment of Healthcare Providers and Systems, or CAHPS, is a nationally standardized survey program overseen by the U.S. Department of Health and Human Services. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ) and was developed to capture the consumer and patient perspective on health care quality.
- CAHPS includes a family of survey tools used across different health care settings. These surveys focus on what patients can directly observe and report—such as access to care, communication, coordination, and overall experience—rather than clinical outcomes alone.
- The CAHPS survey is conducted annually and administered to an anonymous, random sample of members, typically between February/March and June.
- The purpose of CAHPS is to evaluate consumer experience and understand how members perceive key aspects of the care they received in the previous six months.
- Questions focus on how easy it was to get care, how well providers communicated, and whether members felt supported throughout their care journey.
- It is important to understand that member experience and patient satisfaction are not the same thing. A member may report a positive experience—such as feeling listened to or receiving clear instructions—even if the clinical outcome was not what they hoped for. CAHPS specifically measures the experience of care delivery, which is why provider communication, access, and coordination plays such a critical role in CAHPS performance.
Quick Tips to Boost Scores:
- Improve Access: Offer timely appointments and reduce waiting times.
- Communicate Clearly: Use plain language, listen actively, and confirm understanding.
- Coordinate Care: Explain referrals, medications, and follow-ups thoroughly.
- Create a Positive Environment: Keep patients informed and welcome.
- Engage Patients: Use reminders, portals, and education to keep them involved.
The 2025 HEDIS Hybrid Season runs January through April 2025, and your partnership is key to its success. During this period, our health plan may request medical records for dates of service in 2025 or earlier for measures not captured by claims. Requests may come via office visits, fax, mail, or EMR.
Looking ahead, if you are part of our Hybrid sample, expect outreach in Q1 2026 for any additional records needed. Your timely response ensures accurate reporting and supports quality care for our members.
Provider Tips for a Smooth Season
- Stay Organized: Maintain up-to-date records and ensure EMR access is ready for retrieval.
- Respond Promptly: Quick turnaround on requests helps meet deadlines and avoid follow-ups.
- Verify Documentation: Double-check preventive care and chronic condition measures are clearly documented.
- Use Secure Channels: Confirm fax numbers and EMR permissions to streamline record sharing.
- Communicate with Staff: Brief your team on the process to avoid delays and confusion.
Thank you for your continued commitment to delivering high-quality care and supporting HEDIS success!
- Flu Season
- HEDIS Measures
- CAHPS
- Annual Wellness Visits
- Colorectal Cancer Awareness
- Provider Appointment Standards
- Heart and Nutrition
- Telehealth
- Osteoporosis
- HEDIS/CAHPS Measures: Kidney Health, Eye Exam for Patient with Diabetes, Childhood Immunization Status
- Men's Health Screenings
- Medication Errors: Critical Findings and Critical Interventions
- Understanding How We Grasp Our Members' Experience
- Medallia Program
- Patient Experience Video Series - Video #1
What is CAHPS and HEDIS and Why is the Patient Experience Important to you? - Outpatient Mental Health Survey
- HOS Medicare Health Outcomes
- Patient's Advocacy Program
- Video #2 Where to Start When Focusing on Patient Experience?
- Why Is Patient Engagement Important in Healthcare?
- Maximize the Power of an Annual Preventive Visit.
- World Patient Safety Day: Patient Safety from the Start
- Nurses Drive Meaningful Healthcare Outcomes for Patients
- Monthly CAHPS Tips: Rating of all Health Care Quality
- Monthly HEDIS® Tips: Breast Cancer Screening
- HEDIS Measure: BPD Blood Pressure Control for Patients
- CAHPS Tips: Care Coordination
- Educating Patients About Flu
- Preventing Clinic OP Infections
- Mo CAPHS Helping Patients Get Needed Care
- Mo HEDIS Preventive Care
- CAHPS Tips: Advising Smokers and Tobacco Users to Quit
- HEDIS Tips: WCC: Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents