The EmblemHealth Care Management program, including the written plan and criteria, is evaluated and approved at least annually, or as necessary, by the Quality Improvement Committee, EmblemHealth's Board of Director's Quality Improvement subcommittee and the Board of Directors.
Glossary terms found on this page:
Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.
The process to objectively and systematically monitor and evaluate the quality, timeliness and appropriateness of covered services, including both clinical and administrative functions, to pursue opportunities to improve health care and resolve identified problems in any of these services.