We are committed to the provision of a well-designed and well-implemented Quality Improvement (QI) Program. Our culture, systems and processes are structured around its mission to improve the health of all enrolled members.

Scope

The scope of the QI Program is comprehensive and addresses both the quality and safety of clinical care and quality of services provided to MHS members including medical, behavioral health, dental and vision care. We incorporate all demographic groups, care settings, and services in its QI activities, including preventive care, emergency care, primary care, specialty care, acute care, short-term care, long-term care (depending upon MHS products), and ancillary services.

Goals & Objectives

Our primary quality improvement goal is to improve members’ health status through a variety of meaningful quality improvement activities implemented across all care settings and aimed at improving quality of care and services delivered.

Credentialing Standards

For consideration to participate in MHS’ network, all licensed physicians and other licensed healthcare professionals who have an independent relationship with MHS must complete an application for participation and submit copies of applicable supporting documentation.

MHS Case Management Services are provided in an Ethical & Professional Manner:

MHS provides case management services in an ethical manner, based on CCMC and CMSA’s Statement on Ethics and Standards of Practice. Upon your request, information on MHS policies and standards regarding its ethical framework for case management, are available to:

• Staff
• MHS/NHP Members
• Consumers
• Contractors
• Client

URAC Accreditation:

MHS receives URAC accreditation for Case Management and Health Plan.

Certificate of Full Accreditation – Case Management

Certificate of Full Accreditation – Health Plan

For more information on URAC, please visit www.urac.org.

Please contact us at (888) 713-6180 to request to speak with MHS’s Compliance Officer.