Medical Management
- What constitutes a covered service? How are "medically necessary" or appropriate lengths of stay defined?
- What disease management programs are in place ? How do they affect a patient with an existing condition?
- What preventive health care programs are in place, e.g., vaccines, immunizations, mammograms, health club membership reimbursement, etc.?
- Are there other optional covered services? If so, which ones?
- Can the plan provide HEDIS data? If not, why not?
- Does the plan have a quality assessment program in place?
- Please explain internal or external appeals processes.
- Is there a program in place to address medical errors?
HEDIS is a registered trademark of the National Committee for Quality Assurance.
Page last updated on: Dec 21, 2010
Page last modified: December 21, 2010
