WE OFFER A VARIETY OF SERVICES TO MEET YOUR EVERY NEED

Quality Assurance Reporting Requirements, commonly known as HEDIS, or in NY, QARR, is a NYS Department of Health tool for monitoring Medicaid health plan performance.  Each year, Plans submit data on five performance areas, Effectiveness of Care, Access to/Availability of Care, Satisfaction with the Experience of Care, Membership and Use of Services.

HEDIS results, which are published and available to the public, provide benchmarks of care and opportunities for quality improvement. The results can also increase the number of enrollees, by self-selection and/or the auto-enroll process.

JRC Health Care Consultants, Inc. provides excellent results to its clients in the area of medical record retrieval and review.  The following is a list of the services provided.

  • Experienced medical record reviewers conduct thorough reviews of records in all hybrid sample
  • Our medical record reviewers are familiar with the provider communities in their assigned areas and have developed long term relationships with key office personnel.
  • Our medical record reviewers are experienced in abstracting data from multiple electronic medical records, conducting the reviews remotely and on site
  • JRC Health Care Consultants, Inc. conduct inter rater reliability activities as required by NCQA and monitored by IPRO
  • The success of our HEDIS services is measured by the accurate abstraction of data and the relentless pursuit of the records that are not submitted in a timely manner or not at all
  • Our success is demonstrated by increasing compliance scores and placing the health plan in contention for NYS incentive payments

JRC Health Care Consultants, Inc. has provided a DSRIP with support by working closely with the NYS medical record review vendor.

  • Our staff attend meetings with the vendor and report back to the DSRIP on matters of importance and recommends actions accordingly
  • Our staff works alongside the vendor to assist in chases to maximize the medical record hit ratio
  • Our staff educates the participating providers of the PPS on the DSRIP program and the specific information required.  They facilitate obtaining medical records as needed
  • Our staff in 2017, MY3, successfully assisted the vendor in obtaining more than the required collection rate, and improved quality metrics on all measures

JRC Health Care Consultants, Inc. conducts initial and ongoing personal care assessments according to the requirements set forth by NYS DOH

  • JRC Health Care Consultants, Inc. schedules our registered nurses to conduct the assessments assigned to us by the managed care companies
  • Assessments are conducted within the time frame required
  • Assessments are entered into the Uniform Assessment System for New York (UAS-NY) within 24 hours of completion
  • Plans of Care are submitted to the managed care company within 24 hours of completion
  • In most cases, the same nurse conducts the initial and ongoing six month reviews assigned, giving the member a level of comfort with the reviewing nurse
  • JRC Health Consultants, Inc. provides experienced bilingual nurses to facilitate the assessment process
  • Coverage area includes but not limited to Westchester, Dutchess, Putnam, Orange, Rockland, Sullivan, Ulster Counties and the 5 Boroughs