Reviewers Score Sheet Application Questions Total PR PR PR PR Curr Geo NCM/ Pt Inv % Med NCQA EHR BH E #1 E #2 E #3 E #4 E #5 E #6 (max (max Pedi 1 2 3 4 Care Dist CC Cap (max 2) (max 3) (max 1) 4) 3) (max (max (max (max (max (max (max 78) # (if (max 1) (max 2) (max 2) 10) 10) 10) 10) 10) 10) applicable) 1 2 3 4 5 6 7 8 9 10
Reviewers Score Sheet Application Questions Total # PR 1 PR 2 PR 3 PR 4 (if applicable) Curr Care (max 1) Geo Dist (max 2) NCM/ CC Cap (max 2) Pt Inv (max 2) % Med (max 3) NCQA (max 1) EHR (max 4) BH (max 3) E #1 (max 10) E #2 (max 10) E #3 (max 10) E #4 (max 10) E #5 (max 10) E #6 (max 10) Pedi (max 78) 1 2 3 4 5 6 7 8 9 10
CTC%20RI%202017%20Application%20PCMH%20Kids%204.21.17%20%20FINAL.docx