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Administrative Resources

Medica Administrative Manual Home > Health Management and Quality Improvement

Health Management and Quality Improvement

Policies, Procedures, and Resources

Appointment Access and Office Wait Time: Acceptable time standards for patients making appointments and for wait times in the office.

Care Management: Information on the Health Pregnancy, Pediatric Case Managment, Transplant Case Management, Adult Case Management, Restricted Recipient and Medicare/Medicaid Specific Programs and Benefit Appeals.

Centers of Excellence: Information on this program and access to a list of approved providers.

Clinic Site Survey: Procedures for conducting a practitioner office site-related complaint survey.

HIPAA Business Associate Requirements for Providers: Detailed information for the Privacy Rule from the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Medical Policies: Find current versions of Medica utilization management (UM) policies, coverage policies, drug management policies, Institute for Clinical Systems Improvement (ICSI) guidelines, and Medica clinical guidelines.

Member Rights and Responsibilities: Outlines Medica members' legal rights and responsibilities.

Medical Record Review: Examination and improvement of medical practice performance.

Minnesota Department of Health ("MDH") Certified Health Care Homes: Information and requirements for primary care physicians or their clinics that become MDH certified as health care homes.

Provider Responsibilities: How Medica works with participating providers to maintain high-quality, cost-effective health care, including termination and continuity-of-care requirements.

Quality Guidelines and Improvement: Encompasses a wide range of clinical and service quality initiatives.

Reporting Obligations: Find information and forms intended for Medica network providers to use in responding to reporting obligations required by law, contract or accreditation standards (including those required by the National Committee for Quality Assurance, or NCQA®).

Restricted Recipient Program: The Minnesota Restricted Recipient Program (MRRP) identifies suspected cases of abuse of health services or prescription drugs by members.

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