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Quality Improvement



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The Quality Improvement Program implements mechanisms to identify, monitor, evaluate, and resolve issues that impact the accessibility, availability, continuity, and quality of care and service provided to our members. Key objectives include the following:

  • Monitor access and availability to medical and behavioral health care, as well as services and implement corrective action for improvement as identified
  • Provide communication with members, physicians, and providers on issues of quality medical care to promote improvements in the health status of members
  • Develop and distribute information that improves knowledge regarding clinical safety, general wellness and disease prevention as it relates to self care
  • Monitor and evaluate quality of care, quality of service, member satisfaction and provider satisfaction and implement interventions as needed
  • Maintain mechanisms to ensure that cost containment activities do not adversely affect the quality of care provided to members


Responsibilities of Blue Cross and Blue Shield of Oklahoma

  • Qualified staff is properly trained for the Quality Assurance/Quality Improvement (QA/QI) program with oversight by a licensed physician.
  • Health care practices are monitored and evaluated for the sole purpose of improving the quality of care and quality of services rendered by participating providers.
  • All information obtained by the QA/QI staff is used solely for the purpose of improving member care through quality management. Such information is confidentially maintained and protected.
  • A variety of evaluation methods are used, such as surveys, access studies, medical record reviews, clinical studies and utilization studies.
  • The written Quality Improvement program is updated at least annually. Information is available to providers regarding activities of the QA/QI program. We appreciate your willingness to work with and would be glad to share our annual report with you. A copy may be obtained by making a request to:

    Medical Director, Healthcare Quality
    Blue Cross and Blue Shield of Oklahoma
    1400 South Boston
    Tulsa, OK 74119-3612

Responsibilities of the provider

  • Supply complete and detailed clinical information to allow Blue Cross and Blue Shield of Oklahoma to make an informed decision
  • Participate in Quality Assurance/Quality Improvement activities, including provider surveys and on-site visits.
  • Cooperate with QA/QI staff to provide medical records or other appropriate medical information upon request and in a timely manner.

Patient Access to Care — Blue Cross and Blue Shield of Oklahoma access standards

Provider Standards of Care — Medical record documentation standards

Physical setting and safety standards

Quality Program Review