PO Box 016960 (LC-2940)
Miami, FL 33101
800-294-8642, ext. 4
305-243-7270, ext. 4
877-520-6254 TTY callers
UMBH Provider Manual
QI Program Overview
Improving Care and Service
Clinical Practice Guidelines
- Major Depressive Disorders practice guidelines
- ADHD practice guidelines
- Substance Use Disorders practice guidelines
- Panic Disorder practice guidelines
- Bipolar Disorders practice guidelines
- Suicidal Behaviors practice guidelines
- Schizophrenia practice guidelines
- Management of Children with Autism Spectrum Disorders practice guidelines
- Psychiatric Consultation practice guidlines
Continuity and Coordination
- Expectations for Exchanging Information
- UMBH Exchange of Information Form
- UMBH Coordination of Care Guidelines
Medical Necessity Criteria
- Utilization Management Notifications
- Standard Outpatient Treatment Forms
- UMBH Outpatient Authorization Guide
Member Rights and Responsibilities (Derechos y Responabilidades de los Afiliados)
Provider Privacy & Confidentiality
- Provider Confidentiality
- HIPAA General Rules
- UMBH Website Privacy Statement
- University of Miami Privacy Notice
Preventive Health Programs and Patient Safety Information
- ADHD Program
- MDD Program
- Targeted Care Management Program
- Post Partum Depression Program
- Patient Safety
- Treatment Records
- Treatment Record Keeping Standards
- Treatment Record Review Guidelines
- Treatment Records Review Results
- Behavioral Health Documentation Manual
Florida Medicaid Information
Community Links and Resources
Quality Improvement Program Overview
UMBH’s Quality Improvement Program is designed to improve the quality of clinical care and service that is provided to members. We continually monitor and assess our performance in areas we consider key to providing quality care, excellent customer service and improving member safety. The Quality Improvement Program includes activities designed to measure and assess performance in areas such as:
- availability, the time it takes members to reach practitioners and facilities, and the number of practitioners and facilities required per 1000 members.
- accessibility, the time for members to be offered appointments for routine care, urgent care, non-life-threatening emergent care, psychiatric medication evaluations, psychiatric consults, and psychological testing.
- accessibility statistics for how quickly members receive assistance when calling UMBH by telephone and the abandonment rate of calls.
- member satisfaction activities that include annual surveys and analysis of complaints and appeals.
- adherence to clinical practice guidelines. continuity and coordination of care within the behavioral health continuum and between behavioral health and medical delivery systems and practitioners.
- specific clinical quality improvement activities
- monitoring and improving the number of members who complete an initial outpatient appointment within 30 days of discharge from inpatient care for a behavioral health condition
- monitoring and improving the number of members under age 18 who complete four or more outpatient visits within 90 days of an ADHD diagnosis increasing community tenure for individuals with severe mental illness
The Quality Improvement Committee (QIC) oversees implementation of the Quality Improvement Program. The QIC is chaired by the Medical Director and includes a range of practitioners who treat members in all settings. The QIC sets standards and goals for measurement activities, collects data to measure performance against the standards and goals, analyzes data, determines interventions to improve performance, oversees implementation of the interventions, and schedules remeasurement to evaluate the effectiveness of interventions. The Quality Improvement Director oversees and implements the activities of the Quality Improvement Program and, in collaboration with the Medical Director, prepares an annual evaluation of the Quality Improvement Program.
The QIC monitors UMBH compliance with standards set forth by accreditation bodies and regulatory agencies, including, but not limited to, the National Committee for Quality Assurance (NCQA), the Center for Medicare and Medicaid Services (CMS) and the Agency for Health Care Administration (ACHA).
If you would like more information about the Quality Improvement Program, or paper copies of materials, please contact the UMBH QI Department at 1-800-294-8642, or send an e-mail to firstname.lastname@example.org. We welcome your comments and ideas about how we can improve our care and services.