NEW Provider Scorecard – Empowering providers to maximize the impact of their services

NEW Provider Scorecard – Available for all Primary Care Physicians

Texas Children’s Health Plan has created the Provider Scorecard to equip primary care physicians with metrics that will help maximize the value of their services while optimizing costs.

The Provider Scorecard contains key information regarding Quality, Service and Cost metrics. By placing this data under one location, Texas Children’s Health Plan is giving PCPs the opportunity to take actionable steps towards a better outcome for them, the health plan, and our members.

Quality

The Quality section of the scorecard will give providers an overview of their Healthcare Effectiveness and Data Information Set (HEDIS) measures. This information can help health care providers in the following ways:

• Review their score and see how they compare to other Texas Children’s Health Plan PCPs.
• Assess what HEDIS measures have the most opportunity for improvement, resulting in improved services for members while generating higher revenue.
• Pull data of non-compliant members to create outreach efforts that allow for improved quality measures.

Service

The Service section is evaluated based on Member Engagement and Claims Denial Rate and helps health care providers to:

• Understand the top 5 reasons why claims are being denied
• Work with their office staff to increase coding accuracy, which results in faster payment of claims
• Review monthly engagement trends which allows them to plan accordingly to prevent profit dips

Cost

The Cost section is evaluated based on the Claims Expense Ratio (CER), the Claims Turnaround Time and Percentage of Claims Paid within 30 days. This data helps health care providers to:

• Get clarity in data between them and Texas Children’s Health Plan
• Review how Texas Children’s Health Plan is doing for them, including how quickly they are getting paid.

The Provider Scorecard also contains a Provider Roster tab, which allows providers to manage their own panel to improve data accuracy between them and the Health Plan.

To learn more about the new Provider Scorecard, please contact your assigned Provider Relations Liaison TODAY.

The Provider Scorecard is currently only available for Primary Care Physicians.