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Effective Date:

Approval Date:

Updated and amended effective August 24, 2001

13

and under utilization of health services. In addition, each CHIP Contractor is required to submit specific utilization data to the Department on a quarterly and annual basis. The data includes:

• the number of enrollee visits to primary care physicians, medical specialists, as well as visits for vision, hearing, dental, and mental health services. • the number of prescriptions and the ten most utilized drugs; and • the number of hospital admissions for medical, surgical, maternity, mental health and substance abuse and average length of stay, by age group.

The data collected is analyzed by the Department to identify outliers and potential utilization issues. The Department then works with the plans to further evaluate the outliers and correct problems as necessary during its ongoing utilization review and quality improvement programs.

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Page 13

Official source

Effective Date:

Approval Date:

Updated and amended effective August 24, 2001

13

and under utilization of health services. In addition, each CHIP Contractor is required to submit specific utilization data to the Department on a quarterly and annual basis. The data includes:

• the number of enrollee visits to primary care physicians, medical specialists, as well as visits for vision, hearing, dental, and mental health services. • the number of prescriptions and the ten most utilized drugs; and • the number of hospital admissions for medical, surgical, maternity, mental health and substance abuse and average length of stay, by age group.

The data collected is analyzed by the Department to identify outliers and potential utilization issues. The Department then works with the plans to further evaluate the outliers and correct problems as necessary during its ongoing utilization review and quality improvement programs.