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Quality

We are committed to providing our members with quality health care. Find out what we expect from our contracted providers.

Quality Management

We want to be as transparent as possible about the expectations we have of our providers. Our Quality Assessment and Performance Improvement (QAPI) Program exists to ensure that members receive access to high-quality care and services in an appropriate, comprehensive, and coordinated manner that meets or exceeds community standards.
The scope of our QAPI program includes, but is not limited to, the following elements of care and service:

  • Accessibility and availability of services
  • Member satisfaction
  • Quality, safety and appropriateness of clinical care
  • Clinical outcomes
  • Performance improvement projects
  • Service monitoring
  • Clinical practice guidelines and evidence-based practices

We partner with the Colorado Department of Health Care Policy and Financing and the Health Services Advisory Group to administer three satisfaction surveys throughout the year.

We evaluate the impact and effectiveness of the QAPI program on an annual basis and use this information to improve operational systems and clinical services. Information about the program and summaries of results are available to providers and members upon request and is also published in provider and member newsletters.

Accessibility and Availability of Services

Excessive wait times leave members dissatisfied with both their health care provider and health plan. We request that our network providers adhere to state and federal standards for appointment availability for members. If you are unable to provide an appointment within the required timeframes, listed below, please refer the member to us so we can help them find the care they need in a timely manner.

We monitor your compliance with appointment standards in the following ways:

  • Surveys
  • Member grievance monitoring
  • Secret shopper evaluation of appointment availability
Medicaid Physical Health Medicaid Behavioral Health Child Health Plan Plus
Routine Care 45 Calendar Days 7 Days 7 Days
Non-Urgent Care 10 Calendar Days 7 Days 7 Days
Urgent Care 48 Hours 15 Mins 15 Mins

Quality of Care Concerns and Critical Incidents

A quality of care concern is a complaint made concerning a provider’s competence or care that could adversely affect the health or welfare of a member. Examples include prescribing a member the wrong medication or discharging them prematurely. You must report any potential quality of care concerns that you identify during a course of treatment of a member. The identity of any provider reporting a potential qualityof care concern is confidential. Our medical director will review each quality of care concern and score it based on the level of risk/harm to the patient. A facility might receive a call/letter about the incident that includes education about best practices; a formal corrective action plan; or could be terminated from our network. Quality of care concerns can be reported by filling out the form located online at coaccess.com/providers/forms/ and emailing it to qoc@coaccess.com.

Please note that the reporting of any potential quality of care concerns is in addition to any mandatory reporting of critical incidents or child
abuse as required by law or applicable rules and regulations. Please refer to your provider agreement for details. If you have additional question, please call us.

Comprehensive Records

Providers are responsible for maintaining confidential medical records that are current, detailed and organized. Comprehensive records help facilitate communication, coordination and continuity of care, as well as effective treatment. We may perform patient record audit/chart reviews to assure compliance with our standards. For the specific requirements, see section 3 of the Provider Manual.