103 Does your DM program reporting include the following outcomes from all diabetes education programs: personal goal Yes No attainment, weight loss, improved physical activity, improved nutrition, tobacco cessation, or reduced medication? Briefly list what is included in your subrogation services. Internal 104 Do you perform subrogation internally? Or, do you External use an outside vendor? 105 Under what circumstances, or at what dollar threshold do you send a subrogation claim to an outside vendor? 106 Will you offer both health care systems (i.e., Yes No Lovelace and Presbyterian) in Albuquerque? 107 Does your network include the University of NM Yes No Hospital and UNM physicians?. Has your HMO / POS / PPO received NCQA NCQA Yes No / URAC accreditation? If yes URAC Yes No NCQA __________ When? URAC ___________ Accreditation expiration date? NCQA ___________ URAC ___________ 108 Do your network hospitals participate in the Yes No Project? “Leapfrog” 109 Do you have established procedures for when a physician terminates, and a member is in Yes No with that physician? 110 Identify your HMO by type (e.g., IPA, Group, etc.). Do you offer E-Visit or Telehealth services? Yes No If yes, please briefly answer the following: Usage in 2011, on a PMPY basis?
103 Does your DM program reporting include the following outcomes from all diabetes education programs: personal goal attainment, weight loss, improved physical activity, improved nutrition, tobacco cessation, or reduced medication? Yes No Briefly list what is included in your subrogation services. 104 Do you perform subrogation internally? Or, do you use an outside vendor? Internal External 105 Under what circumstances, or at what dollar threshold do you send a subrogation claim to an outside vendor? 106 Will you offer both health care systems (i.e., Lovelace and Presbyterian) in Albuquerque? Yes No 107 Does your network include the University of NM Hospital and UNM physicians?. Yes No Has your HMO / POS / PPO received NCQA / URAC accreditation? If yes NCQA Yes No URAC Yes No When? NCQA __________ URAC ___________ Accreditation expiration date? NCQA ___________ URAC ___________ 108 Do your network hospitals participate in the “Leapfrog” Project? Yes No 109 Do you have established procedures for when a physician terminates, and a member is in with that physician? Yes No 110 Identify your HMO by type (e.g., IPA, Group, etc.). Do you offer E-Visit or Telehealth services? Yes No If yes, please briefly answer the following: Usage in 2011, on a PMPY basis?
Appendix%20G%20Questionnaire.docx