Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Centene > Acronyms > Flashcards

Acronyms Flashcards

(58 cards)

Start Studying
1
Q

NCQA

A

National Committee for Quality Assurance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Chart Chase

A

the searching of data points in relation to the healthplan to collect data records from providers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Key Measures

A

The actual data points that are being used this HEDIS season

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Numerator

A

The number of people that have completed the measure and added to its total

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Denominator

A

The number of people that are being measured against in the random data set (usually 411)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MRSS

A

Minimum Required Sample Size. When selecting a sample size, this is the required number of members in the sample (may be able to reduce sample using Table 2 in sampling guide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

HOQ

A

The totals that we provide back to the healthplan to show rates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CIOX

A

A vendor that stores/collects medical records - (usually contract); Chart Retrieval Vendor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

QSI XL

A

Internal Tool used to generate the sample, compiles the admin refresh (collects 3 types of data: Supplemental Data, Chart Chase, Admin Data); The tool used to build the project

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hybrid Data

A

3 types of data: Supplemental Data, Chart Chase, Admin Data

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

QSHR

A

A project management tool used by all members to show the active project status and see the rate information in real time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pend Codes

A

A code that is used by the healthplan to explain why they have been unable to locate a certain medical record

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Scrub

A

A task of the Healthplan to call vendors and make sure that the location of medical data is the same

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pre-Scrub

A

Location of medical records from last year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

PCRDD

A

Location of scrub on the centene side, used to slowly improve our data over time (Provider Chart Retrieval Demographics Database)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Project Build

A

Data Driving where we put together the excel spreadsheets required to show the ratio of completion of the measures, used to generate Rates.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Rates

A

The overall cost to the patient based primarily on the star system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Star System

A

Used to show the % of completion to a measure (x/411 = ratio = 1 - 5 stars)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Chase Rules Logic

A

collecting a data point toward the sample set to get better rates that was previoulsy not collected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Org ID

A

A number used to designate a state specific HEDIS measure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Sub ID

A

A number used to designate a state specific Org ID based on HEDIS submeasures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Abstraction

A

The process of reviewing a member’s legal medical record for documentation that a specific event occurred within the required timeframe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Abstraction Errors: Critical Errors

A

Impact the compliancy of the measure: missed event that makes member compliant, event abstracted that did not occur, event abstracted incorrectly that should not be counted (incomplete measure or date error), HIPAA Issue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Abstraction Errors: Non-Critical Errors

Study These Flashcards
A

Do NOT impact the compliancy: data error that doesn’t affect compliancy, date entered incorrectly but still within time parameters for compliancy

25
APC
Adolescent Preventive Care
26
Appendix 1
The Appendix 1 is part of the NCQA ROADMAP (Record of Administration, Data Management and Processes) process, and is one of the first steps in preparing for HEDIS reporting. The Appendix 1 is an Excel spreadsheet used to identify the Health Plan organization demographics, product types, covered benefits, NCQA identifiers (e.g., organization/submission identification numbers), HEDIS measure reporting method designations (e.g., A=Administrative, H=Hybrid, S=Survey, etc.), and any state specific reporting information if an NCQA audit is required.
27
CAHPS
Consumer Assessment of Healthcare Providers and Systems
28
Change Healthcare (CHC)
Chart Retrieval AND/OR Abstraction Vendor (formerly Altegra as referred to in QSHR vendor flags)
29
Chases
Attempt to retrieve a medical record from a provider
30
HAT
Hybrid analytics team (within Centene)
31
HUI
HEDIS User Interface: Used to close member gaps through year-round medical record review. Provides a standardized, automated mechanism for HP to add any nonstandard supplemental data collected, following NCQA specifications and auditor approval, to support HEDIS reporting requirements
32
HUI-Q
A web application used to centralize medical records attached to a chase and only used during the HEDIS hybrid season
33
IDSS
Interactive Data Submission System; The audited totals that are finalized for the year
34
Inovalon
Vendor of QSI-XL and QSHR
35
Measure
Specific data point utilized to gauge compliance with outlined NCQA standards
36
Measurement Year
Data Year (i.e., year prior to reporting year) For HEDIS 2020, the measurement year is 2019
37
MMP
Medicare/Medicaid Plan
38
MRR
Medical Record Review
39
MRRV
Medical Record Review Validation. Validation (By Auditor) of the accuracy of the abstraction by reviewing a sample of medical records against the technical specifications.
40
MRSS
Minimum Required Sample Size. When selecting a sample size, this is the required number of members in the sample
41
Overread
The process of reviewing already-complete abstraction to ensure it was abstracted in compliance with the specifications
42
QSHR
Quality Spectrum Hybrid Reporter. This is an Inovalon product created for hybrid review only. Corporate staff hosts the software with Corporate IT and the Quality Improvement staff supporting and maintaining the software and the process of creating, loading, and updating the hybrid data on behalf of all Centene Plans.
43
Supplemental Data
Any data that is not contained in a medical claim. The data supplements or adds to the completeness of the information applicable to the member and quality reporting. There are 2 types: Standard & Nonstandard
44
ABA
Adult BMI Assessment
45
COL
Colorectal Cancer Screening
46
CBP
Controlling High Blood Pressure
47
CDC
Comprehensive Diabetes Care
48
MRP
Medication Reconciliation Post-Discharge
49
TRC
Transitions of Care
50
WCC
Weight Assessment & Counseling for Nutrition & Physical Activity for Children & Adolescents
51
CIS
Childhood Immunization Status
52
IMA
Immunizations for Adolescents
53
CCS
Cervical Cancer Screening
54
PPC
Prenatal & Postpartum Care
55
COA
Care for Older Adults
56
W15
Well-Child Visits in 1st 15 Months
57
W34
Well-Child Visits in 3, 4, 5 & 6 Years of Life
58
AWC
Adolescent Well-Care Visits

Centene (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions