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Process Group

Provider quality management

Objective

Ensure that the provider has delivered the necessary contracted quality of service

Input

  • Formulary

  • Service-level agreement with provider

  • Clinical protocol and guidelines

  • Claims

  • Case notes

  • Patient records

  • Complaints

Output

  • Quality review report

  • Quality rating

  • Update provider credentialing status

Measurable Outcomes

  • Re-admission rates

  • Mortality rates

  • Infection rates

  • Caesarean section (c-section) rates

  • Decision on whether or not to contract for provider at a particular fee

Source

  • No labels

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