Name of Manual - Blue Cross and Blue Shield of Minnesota

Table of Contents
Chapter 3
Quality Improvement
Introduction to Quality Improvement ..................................................................................... 3-2
General Overview ..................................................................................................................3-2
Basic Elements of a QI Program............................................................................................3-2
Leadership..............................................................................................................................3-3
Quality Improvement Projects ..............................................................................................3-3
Cooperation with Blue Cross QI Program............................................................................. 3-4
Telephone Care: During Office Hours...................................................................................3-4
Telephone Care: In-coming Calls .......................................................................................... 3-4
Telephone Care: After Hours.................................................................................................3-5
Complaint Review System..................................................................................................... 3-6
Quality of Care Complaints ...................................................................................................3-7
Access & Availability............................................................................................................3-7
Written Policies......................................................................................................................3-8
Continuity and Coordination of Care................................................................................... 3-11
Patient Safety .......................................................................................................................3-12
Medical Record Keeping Practices...................................................................................... 3-13
Medical Record Documentation .......................................................................................... 3-14
Clinical Practice Guidelines.................................................................................................3-16
Quality Improvement for Behavioral Health Providers ...................................................... 3-19
General Overview ................................................................................................................3-19
Cooperation with Blue Cross QI Program........................................................................... 3-19
Complaint Review System................................................................................................... 3-20
Additional requirements for Select Network Providers....................................................... 3-20
Access and Availability .......................................................................................................3-20
Physical Facility...................................................................................................................3-21
Written Provider Policies..................................................................................................... 3-22
Treatment Record Documentation.......................................................................................3-23
Blue Cross Blue Shield of Minnesota Provider Policy and Procedure Manual (08/11/11) 3-1