Quality Improvement Resources

Welcome to our Quality Improvement Resources! At Aetna Better Health of Pennsylvania, we value our provider partners. We want to make it easy for you to care for our members and guide them down the path to better health.

To achieve this goal we have developed the Quality Improvement Resources. This resource will benefit you in the following ways:

  • Help improve HEDIS Ratings, Pay for Quality Scores, and incentive payments
  • Provide coding tips from the National Committee for Quality Assurance (NCQA)
  • Allow easy access to important provider documents and tools.

Quality Measure Educational Documents include both HEDIS measures developed by the NCQA and Performance Measures for the State of Pennsylvania

Access and Availability of Care (AAP)
Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA)
Ambulatory Care (AMB)
Antibiotic Utilization (ABX)

Antidepressant Medication Management (AMM)

Annual Percentage of Asthma Patients With One or More Asthma-Related Emergency Room Visits

Appropriate Treatment for Pharyngitis (CWP)
Appropriate Treatment for Upper Respiratory Infection (URI)
Asthma Medication Ratio (AMR)
Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB)
Breast Cancer Screening (BCS)
Cardiac Rehabilitation (CRE)
Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia (SMC)
Cervical Cancer Screening (CCS)
Child and Adolescent Well Visit (WCV)
Childhood Immunization Status (CIS)
Chlamydia Screening in Women (CHL)
Comprehensive Diabetes Care (CDC)
Concurrent Use of Opioids and Benzodiazepines (COB)
Contraceptive Care for All Women Ages 15-44 (CCW)
Contraceptive Care for Postpartum Women Ages 15-44 (CCP)
Controlling High Blood Pressure (CBP)
Developmental Screening in the First Three Years of Life (DVS)
Diabetes Monitoring for People with Diabetes and Schizophrenia (SMD)
Diabetes Screening for People with Schizophrenia or Bipolar Disorder (SSD)
Flu Vaccinations for Adults Ages 18-64 (FVA)
Follow-Up After Emergency Department Visit for Alcohol and Dependence (FUA)
Follow-Up After Emergency Department Visit for Mental Illness (FUM)
Follow-Up After High-Intensity Care for Substance Use Disorder (FUI)
Follow-Up After Hospitalization for Mental Illness (FUH)
Follow-Up Care for Children Prescribed ADHD Medication (ADD)
Identification of Alcohol and Other Drug Services (IAD)
Immunizations for Adolescents (IMA)
Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
Inpatient Utilization (IPU)
Kidney Health Evaluation (KED)
Lead Screening in Children (LSC)
Maternity: Prenatal and Postpartum Care (PPC)
Medical Assistance With Smoking and Tobacco Use Cessation (MSC)
Mental Health Utilization (MPT)
Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
Pennsylvania Admission Rate Performance Measures
Perinatal Depression Screening
Persistence of Beta-Blocker Treatment After a Heart Attack (PBH)
Pharmacotherapy for Opioid Use Disorder (POD)
Pharmacotherapy Management of COPD Exacerbation (PCE)
Plan All Cause Readmission (PCR)
Perinatal Smoke Screening
Risk of Continued Opioid Use (COU)
Statin Therapy for Patients With Cardiovascular Disease (SPC)
Statin Therapy for Patients With Diabetes (SPD)
Use of First - Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP)
Use of Imaging Studies for Low Back Pain (LBP)
Use of Opioid from Multiple Providers (UOP)
Use of Opioids at High Dosage (HDO)
Use of Pharmacotherapy for Opioid Use Disorder (OUD-AD)
Use of Spirometry Testing in the Assessment (SPR)
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)
WellChild - 1st 30 months of Life (W30)



Practitioner Information Change Form

When you need to update information for you practice, i.e. adding a new PCP to your roster, this form needs filled out and sent in to the plan.

Provider Secure Web Portal Registration Form

Register for this portal to access claims information, member panels, additional forms, the Provider Report Management Tool, and much more!

Member Care Information Portal Registration Form

Register for this portal to electronically upload Obstetrical Needs Assessment Forms (ONAFs). Incentives are tied to electronic uploads in the P4Q Program.

Patient Record of Care Form

Provide this form to members that may be attending screening events where codes are not submitted. This signed form can be added to the patient's record and count towards your HEDIS scores!

Case Management Special Needs Referral Fillable Form

Aetna Better Health of Pennsylvania and Aetna Better Health Kids encourage our provider network to continue to provide family planning options to your patients, incorporate long-acting reversible contraceptives (LARC) counseling, and support access to LARC in all clinically appropriate circumstances.

Long-Acting Reversible Contraception (LARC)

 HEDIS Measures Overview reference guide 

Provider Portal Quick Tips

This guide walks you through utilization of the secure web portal

Member Care Information Portal Guide

Learn how to upload ONAFs electronically to the Member Care Information Portal

Provider Report Management Tool Overview and Navigation

Learn how to access this tool where you can pull Quality Reports such as HEDIS Gaps in Care

Medicaid Pay-for-Quality (P4Q) Tip Sheet

You may be eligible to earn more compensation with our Pay for Quality (P4Q) program! Refer to this tip sheet for information on the program, eligibility, and incentives

Trauma-Informed Care

Understanding Social Determinants of Health ICD-10 Codes

Community Health Workers Maternity Program Overview

Caring for Patients with Developmental Disabilities

View past webinars to learn how you can improve HEDIS rates and member health outcomes.

For a complete listing of all offerings in 2021 click here.