Trainings and Orientation New Provider OrientationQuality 101: Overview of Quality; Quality of Care & Safety; Quality Processes & Provider Expectations; Quality ImprovementComplaints - a member complaint is a dispute, issue or objection presented by or on behalf of a member regarding a provider, behavioral health coverage, or Community Care.Denials and Grievances - a request for authorization to provide a service of a specific amount, duration and scope and a request to reverse Community Care's decision to deny authorization of a service.Provider Performances Issues (PPIs) - PPIs monitor the providers adherence to expectations, guidelines, performance standards and best practices.Provider Benchmarking: - an annual activity focusing on systemic improvement of high-volume providers.Record Reviews - record reviews may occur as routine activities or an ad hoc activity due to member/provider incidents, quality of care concerns and/or due to a member complaint.Significant Member Incidents (SMIs) - providers are required to report incidents to Community Care within 24 hours of incident or provider learning of the incident.SMI Categories Module 1SMI Reporting Process Module 2Satisfaction Surveys - member and provider feedback regarding satisfaction through member and provider satisfaction surveys and Consumer/Family Satisfaction Teams (C/FST).Quality Improvement PlanFrequently Asked Questions about Quality Improvement Plans Single-indicator exampleSingle-indicator template (Word)Single-indicator template (Excel) Multi-indicator exampleMulti-indicator template (Word)Multi-indicator template (Excel)