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Centene > Acronyms > Flashcards

Acronyms Flashcards

1
Q

NCQA

A

National Committee for Quality Assurance

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2
Q

Chart Chase

A

the searching of data points in relation to the healthplan to collect data records from providers

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3
Q

Key Measures

A

The actual data points that are being used this HEDIS season

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4
Q

Numerator

A

The number of people that have completed the measure and added to its total

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5
Q

Denominator

A

The number of people that are being measured against in the random data set (usually 411)

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6
Q

MRSS

A

Minimum Required Sample Size. When selecting a sample size, this is the required number of members in the sample (may be able to reduce sample using Table 2 in sampling guide)

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7
Q

HOQ

A

The totals that we provide back to the healthplan to show rates

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8
Q

CIOX

A

A vendor that stores/collects medical records - (usually contract); Chart Retrieval Vendor

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9
Q

QSI XL

A

Internal Tool used to generate the sample, compiles the admin refresh (collects 3 types of data: Supplemental Data, Chart Chase, Admin Data); The tool used to build the project

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10
Q

Hybrid Data

A

3 types of data: Supplemental Data, Chart Chase, Admin Data

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11
Q

QSHR

A

A project management tool used by all members to show the active project status and see the rate information in real time

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12
Q

Pend Codes

A

A code that is used by the healthplan to explain why they have been unable to locate a certain medical record

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13
Q

Scrub

A

A task of the Healthplan to call vendors and make sure that the location of medical data is the same

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14
Q

Pre-Scrub

A

Location of medical records from last year

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15
Q

PCRDD

A

Location of scrub on the centene side, used to slowly improve our data over time (Provider Chart Retrieval Demographics Database)

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16
Q

Project Build

A

Data Driving where we put together the excel spreadsheets required to show the ratio of completion of the measures, used to generate Rates.

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17
Q

Rates

A

The overall cost to the patient based primarily on the star system

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18
Q

Star System

A

Used to show the % of completion to a measure (x/411 = ratio = 1 - 5 stars)

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19
Q

Chase Rules Logic

A

collecting a data point toward the sample set to get better rates that was previoulsy not collected

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20
Q

Org ID

A

A number used to designate a state specific HEDIS measure

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21
Q

Sub ID

A

A number used to designate a state specific Org ID based on HEDIS submeasures

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22
Q

Abstraction

A

The process of reviewing a member’s legal medical record for documentation that a specific event occurred within the required timeframe

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23
Q

Abstraction Errors: Critical Errors

A

Impact the compliancy of the measure: missed event that makes member compliant, event abstracted that did not occur, event abstracted incorrectly that should not be counted (incomplete measure or date error), HIPAA Issue

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24
Q

Abstraction Errors: Non-Critical Errors

A

Do NOT impact the compliancy: data error that doesn’t affect compliancy, date entered incorrectly but still within time parameters for compliancy

25
Q

APC

A

Adolescent Preventive Care

26
Q

Appendix 1

A

The Appendix 1 is part of the NCQA ROADMAP (Record of Administration, Data Management and Processes) process, and is one of the first steps in preparing for HEDIS reporting. The Appendix 1 is an Excel spreadsheet used to identify the Health Plan organization demographics, product types, covered benefits, NCQA identifiers (e.g., organization/submission identification numbers), HEDIS measure reporting method designations (e.g., A=Administrative, H=Hybrid, S=Survey, etc.), and any state specific reporting information if an NCQA audit is required.

27
Q

CAHPS

A

Consumer Assessment of Healthcare Providers and Systems

28
Q

Change Healthcare (CHC)

A

Chart Retrieval AND/OR Abstraction Vendor (formerly Altegra as referred to in QSHR vendor flags)

29
Q

Chases

A

Attempt to retrieve a medical record from a provider

30
Q

HAT

A

Hybrid analytics team (within Centene)

31
Q

HUI

A

HEDIS User Interface: Used to close member gaps through year-round medical record review. Provides a standardized, automated mechanism for HP to add any nonstandard supplemental data collected, following NCQA specifications and auditor approval, to support HEDIS reporting requirements

32
Q

HUI-Q

A

A web application used to centralize medical records attached to a chase and only used during the HEDIS hybrid season

33
Q

IDSS

A

Interactive Data Submission System; The audited totals that are finalized for the year

34
Q

Inovalon

A

Vendor of QSI-XL and QSHR

35
Q

Measure

A

Specific data point utilized to gauge compliance with outlined NCQA standards

36
Q

Measurement Year

A

Data Year (i.e., year prior to reporting year) For HEDIS 2020, the measurement year is 2019

37
Q

MMP

A

Medicare/Medicaid Plan

38
Q

MRR

A

Medical Record Review

39
Q

MRRV

A

Medical Record Review Validation. Validation (By Auditor) of the accuracy of the abstraction by reviewing a sample of medical records against the technical specifications.

40
Q

MRSS

A

Minimum Required Sample Size. When selecting a sample size, this is the required number of members in the sample

41
Q

Overread

A

The process of reviewing already-complete abstraction to ensure it was abstracted in compliance with the specifications

42
Q

QSHR

A

Quality Spectrum Hybrid Reporter. This is an Inovalon product created for hybrid review only. Corporate staff hosts the software with Corporate IT and the Quality Improvement staff supporting and maintaining the software and the process of creating, loading, and updating the hybrid data on behalf of all Centene Plans.

43
Q

Supplemental Data

A

Any data that is not contained in a medical claim. The data supplements or adds to the completeness of the information applicable to the member and quality reporting. There are 2 types: Standard & Nonstandard

44
Q

ABA

A

Adult BMI Assessment

45
Q

COL

A

Colorectal Cancer Screening

46
Q

CBP

A

Controlling High Blood Pressure

47
Q

CDC

A

Comprehensive Diabetes Care

48
Q

MRP

A

Medication Reconciliation Post-Discharge

49
Q

TRC

A

Transitions of Care

50
Q

WCC

A

Weight Assessment & Counseling for Nutrition & Physical Activity for Children & Adolescents

51
Q

CIS

A

Childhood Immunization Status

52
Q

IMA

A

Immunizations for Adolescents

53
Q

CCS

A

Cervical Cancer Screening

54
Q

PPC

A

Prenatal & Postpartum Care

55
Q

COA

A

Care for Older Adults

56
Q

W15

A

Well-Child Visits in 1st 15 Months

57
Q

W34

A

Well-Child Visits in 3, 4, 5 & 6 Years of Life

58
Q

AWC

A

Adolescent Well-Care Visits

Centene (1 decks)

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