West Virginia Code of State Rules
Agency 114 - Insurance Commission
Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER
Series 114-56 - Quality Assurance Standards For Prepaid Limited Health Service Organizations
Section 114-56-3 - Goals of a Quality Assurance Program
Universal Citation: 114 WV Code of State Rules 114-56-3
Current through Register Vol. XLI, No. 38, September 20, 2024
3.1. The goals of a prepaid limited health service organization's quality assurance program shall be to:
a. Assure the provision of
appropriate limited health services delivered to members, while simultaneously
addressing the effectiveness of quality of care;
b. Monitor, evaluate and improve the quality of
care for limited health services;
c.
Provide a systematic process that promotes the delivery of appropriate care in a
timely, effective and efficient manner, while maintaining the quality of care for
limited health services;
d.
Direct members and providers toward the goal of quality and cost effective care for
limited health services.
3.2. A prepaid limited health service organization's quality assurance program shall include a mechanism for identifying potential utilization management issues and linking them to the PLHSO's utilization management program.
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