Common use of Provider Profiling Clause in Contracts

Provider Profiling. The Contractor shall conduct PCD Provider and other Participating Provider profiling activities at least quarterly. As part of its QAPI Program, the Contractor shall describe the methodology it uses to identify which and how many Participating Providers to profile and to identify measures to use for profiling such Providers. Provider profiling activities shall include, without limitation: • Developing PCD Provider and other Provider-specific reports that include a multi-dimensional assessment of a PCD Provider or other Participating Provider’s performance using clinical, administrative and Dental Health Plan Enrollee satisfaction indicators of care that are accurate, measurable, and relevant to the enrolled population; • Establishing PCD Provider, other Participating Provider, group, service area, or regional benchmarks for areas profiled, where applicable; and • Providing feedback to individual PCD Providers and other Participating Providers regarding the results of their performance and the overall performance of the Contractor’s Participating Provider network.