DCS Comprehensive Health Plan

Peer Review

Policy No.

Responsible Area

Last Date

Effective Revised

HS-CC-01

Health Coordination

08/31/2023

08/31/2023

Statement/Purpose

DCS Comprehensive Health Plan (DCS CHP) participates in a peer review process to address provider quality of care and service issues.

Scope

The Peer Review process addresses matters where there is evidence of a quality deficiency in the care or service provided, or the omission of care or service, by a participating or nonparticipating health care provider. These issues are addressed in a confidential forum by peers.

[Insert and link legal citations]

Definitions

[List definitions not commonly known that are specific to the policy]

Policy

[Policies are the guiding principles and/or rules that ensure consistency and compliance with DCS CHP’s mission, values and strategic goals]

Procedure

[Procedure are high-level actions that guide adherence to policy. Procedures describe the methods used to comply with policy]

[Insert and link referenced policies]

[Insert all documents, forms etc referenced within the policy] N/A

Reviewed and Revised Date (Month/Year)

Reason for Review

Revision Description

02/2024

Annual Review

Added updates based upon ACOM 103 revisions and updated reporting requirements.

03/2022

Annual Review

Added and revised pertinent information required for health plan integration.