Providers | Blue Shield of California Promise Health Plan

Quality Improvement

Quality Improvement

The Quality Improvement (QI) Department identifies opportunities for improvement of care and services to both our members and providers. This is accomplished by assisting with the identification, investigation, implementation and evaluation of corrective actions that continuously improve and measure the quality of clinical and administrative service. This Quality Improvement Program covers all lines of business, including but not limited to, Medi-Cal and Medicare. A formal evaluation of the Quality Improvement functions is performed annually.

Focus Area

Specific key elements of focus for the Quality Improvement Department may include but are not limited to:

  • Provider accessibility and availability
  • Provider satisfaction
  • Provider credentialing
  • Clinical practice guidelines
  • Under and over utilization
  • Adverse outcomes/sentinel events
  • Medical record keeping practices
  • Facility site reviews
  • Member satisfaction/grievances
  • Timeliness of handling claims
  • High risk and high volume services
  • Oversight of IPA QM function

The Quality Improvement Program is designed to objectively and systematically monitor and evaluate the quality, appropriateness and outcome of care and services delivered to our members and to provide mechanisms that continuously pursue opportunities for improvement and problem resolution.


QI Annual Evaluations/ Program Goals

Blue Shield of California Promise Health Plan administers a robust ongoing Quality Improvement Program with a goal to ensure that members receive the highest quality of care and services.


Provider Notifications/Updates (NCQA )


Initial Health Assessment (IHA)


Facility Site Review Policy and Procedures

Site Accessibility by individuals with physical disabilities; Fire Safety and Prevention and Emergency Non-Medical Procedures; Medical and lab equipment maintenance; Emergency healthcare services; Staff qualifications... Click on the following link for the complete Facility Site Review Policy and Procedures.


Quality Improvement Incentive Program (Q.I.I.P)


More on Quality Improvement

Access to Care Standards, Provider Survey Results, Survey Results (CAHPS®), Study Results (HEDIS®), Click here!

You are leaving Blue Shield of California Health Plan's website

If you enter the web site of Krames on Demand (http://kod.staywellsolutionsonline.com/?accountId=0), please be aware that you will leave Blue Shield of California Health Plan's web site, and will be routed to the Krames on Demand's web site that adheres to the rules, policies, regulations and terms of use of that service.


OK, I understandCancel

You are leaving Blue Shield of California Promise Health Plan's website

If you enter the web site https://ocrportal.hhs.gov, please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Office for Civil Rights web site that adheres to the rules, policies, regulations and terms of use of that agency. If you enter the web site http://www.hhs.gov, please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the U.S. Department of Health & Human Services web site that adheres to the rules, policies, regulations and terms of use of that agency. If you enter the web site of CMS (Centers for Medicare & Medicaid Services) (http://www.cms.gov), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the CMS's web site that adheres to the rules, policies, regulations and terms of use of that service. If you enter the web site https://www.ssa.gov/medicare/prescriptionhelp/, please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Medicare Prescription Drug Plan Costs web site that adheres to the rules, policies, regulations and terms of use of that service. If you enter the web site https://secure.ssa.gov/i1020/start, please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Official Website of the U.S. Social Security Administration that adheres to the rules, policies, regulations and terms of use of that agency. If you enter the web site of Beacon Health Strategies (beaconhealthstrategies.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Beacon Health Strategies web site that adheres to the rules, policies, regulations and terms of use of that service. If you enter the web site My Advocate (www.myadvocatehelps.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the My Advocate web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site American Specialty Health (ASH) (www.ashlink.com/ash/ashco.aspx?hp=Care1st), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the ASH web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Dental Providers (www.deltadentalins.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Dental Providers web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Hearing Services/ Hearing Aids (www.epichearing.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Hearing Services web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site VSP (www.vsp.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the VSP web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site KEPRO (www.keproqio.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the KEPRO web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Livanta (www.bfccqioarea5.com ), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Livanta web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site U.S. Department of Health and Human Services (ocrportal.hhs.gov/ ), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the U.S. Department of Health and Human Services web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site CalDuals (http://calduals.org/ ), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the CalDuals web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site California Department of Health Care Services (https://www.dhcs.ca.gov/ ), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the California Department of Health Care Services web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site CMS (Centers for Medicare & Medicaid Services) (http://www.cms.gov), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the CMS (Centers for Medicare & Medicaid Services) web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site California Department of Health Care Services (DHCS) (https://www.healthcareoptions.dhcs.ca.gov/), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the California Department of Health Care Services (DHCS) web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Medi-Cal Dental Program (https://www.denti-cal.ca.gov/), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Medi-Cal Dental Program web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Solera4me (https://www.solera4me.com/bluepromisemedicare), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Solera4me web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Department of Managed Healthcare (http://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForms.aspx), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Department of Managed Healthcare web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site.