To ensure high quality care and in accordance with Department of Human Services (DHS) and Centers for Medicare & Medicaid Services (CMS) requirements, we must identify, track and follow up on:

• Preventable Serious Adverse Events (PSAE)
• Healthcare-Acquired Conditions (HCAC)
• Other Preventable Provider Conditions (OPPC)

Providers can call our toll-free, anonymous phone line to report events that are deemed preventable, serious and adverse. Please call 855-218-2314 and provide the following information:

• Member’s name and ID number and/or date of birth
• Date of event
• Description of event
• Location where event occurred

All calls are confidential and our Quality Management department will verify the information you provide.

For more information about hospital-acquired conditions and present-on-admission indicator reporting, please review the CMS fact sheet.

Our policy is to reasonably track and isolate identified events, and account for payments that may have been made in association with them. We reserve the right to retract payments for what are deemed preventable events.