External Quality Review definition

External Quality Review and “EQR” each means the analysis and evaluation by an EQRO, of aggregated information on quality, timeliness and access to the health care services that Contractor furnishes to its Members, and other EQR-related activities as set forth in 42 CFR 438.358.

External Quality Review means the analysis and evaluation by an EQRO of aggregated information on quality, timeliness and access to the health care services that the Contractor or its subcontractors furnish to enrollees (42 CFR 438.320).

External Quality Review or “EQR” means the analysis and evaluation by an EQRO, of aggregated information on quality, timeliness and access to the health care services that Contractor furnishes to its Members.

Examples of External Quality Review in a sentence

• Note: States have flexibility in how the evaluation is conducted and may leverage existing resources, such as their 1115 demonstration evaluation if this payment arrangement is tied to an 1115 demonstration or their External Quality Review validation activities, as long as those evaluation or validation activities are specific to this payment arrangement and its impacts on health care quality and outcomes.

• Note: States have flexibility in how the evaluation is conducted and may leverage existing resources, such as their 1115 demonstration evaluation if this payment arrangement is tied to an 1115 demonstration or their External Quality Review validation activities, as long as those evaluation or validation activities are specific to this payment arrangement and its impacts on health care quality and outcomes).

• Annually EQRO QR-10 QR-10 Performance Improvement Projects Performance Improvement Project Reports (Format for submission determined by and communicated by External Quality Review Organization).

• Annually Inter- change QR-09 QR-09 Validation of Performance Measures Performance Measure Data (Format for submission determined and communicated by External Quality Review Organization).

• CHCS appreciates the generous time and knowledge of the following state, health plan, and External Quality Review Organization reviewers: Dr. Janice Carson, Georgia Department of Community Health; Kim Elliott, Arizona Health Care Cost Containment System; Dr. Bonnie Stanley, New Jersey Division of Medical Assistance and Health Services; Kristin LaRoche, DentaQuest; and Gretchen Thompson, Health Services Advisory Group.

More Definitions of External Quality Review

External Quality Review. (EQR) means the analysis and evaluation by an EQRO of aggregated information on quality, timeliness and access to the health care services that the Contractor or its subcontractors furnish to Medicaid recipients (42 CFR 438.320).

External Quality Review. Organization (“EQRO”): An organization that meets the competence and independence requirements set forth in 42 CFR 438.354 and performs analysis and evaluation on the quality, timeliness, and access to Covered Services and Benefits to Enrollees with respect to which the Contractor provides Administrative Services under this Contract. Federally Qualified Health Center (“FQHC”) Services: An entity that provides outpatient health programs pursuant to Section 1905(l)(2)(B) of the Social Security Act. Federally Qualified Health Center (“FQHC”) Services: Services furnished to an individual as an outpatient of an FQHC. Fee-for-Service: A method of reimbursement based on payment for specific Covered Services rendered to an Enrollee.

External Quality Review means the analysis and evaluation by an external quality review organization of the aggregated information on quality, timeliness, and access to the health care services that a managed care organization or the managed care organization's contractor provides to enrollees.

External Quality Review or “EQR” Analysis and evaluation by an EQRO, of aggregated information on quality, timeliness, and access to the health care services that a MCO or their contractors furnish to Medicaid members, as defined in 42 C.F.R. § 438.320. “External Quality Review Organization” or “EQRO” An organization that meets the competence and independence requirements set forth in 42 C.F.R. § 438.354 and performs external quality review, and other EQR related activities as set forth in 42 C.F.R. § 438.358, or both. “Family Planning” Those necessary services that delay or prevent pregnancy. Coverage of such services shall not include services to treat infertility or services to promote fertility. “FAMIS” Family Access to Medical Insurance Security Plan - A comprehensive health insurance program for Virginia’s children. FAMIS is administered by and is funded by the state and federal government. Also referred to as Title XXI or the state’s CHIP (Children’s Health Insurance Program).

External Quality Review means the analysis and evaluation by an EQRO, of

External Quality Review. Organization or EQRO means an organization that meets the competence and independence requirements set forth in §438.354, and performs external quality review, other EQR-related activities as set forth in §438.358, or both. Family Member means all CHIP eligible individuals associated to same eligibility case number, included in the Eligibility Transmission who are members of the same family. Federal Financial Participation or FFP means, in accordance with 42 CFR 400.203, the Federal Government’s share of a state’s expenditures under the Medicaid or CHIP program and is determined by comparing a state’s per capita income to the national average. Federal Acquisition Regulation means the regulation found at Title 48 of the Code of Federal Regulations, Chapter 1, Parts 1 through 53. Federal Health Care Program means (1) any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the United States Government (other than the health insurance program under chapter 89 of title 5, United States Code) of the Social Security Act; or (2) any State Health Care program, as defined in Section 1128(h) of the Social Security Act. Federally Qualified Health Center (FQHC) means a community-based organization that qualifies for funding under Section 330 of the Public Health Service Act (PHS), and that provides comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status.

External Quality Review. ’ means the