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Home > Providers > Resources > Quality Resources

Quality Resources

Adult Body Mass Index (BMI) Assessment Claims Coding Chart PDF
Care for the Older Adults (COA) Claims Coding Chart PDF
Care for Older Adults (COA) Form PDF
CMS Five-Star Quality Rating System and Our Network Providers PDF
Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and Health Outcomes Survey (HOS) Information PDF
Diabetes Coding for HEDIS PDF
HEDIS Incentive Program PDF
Incentive Program - The PerformPlus Stars Total Cost of Care Program PDF
Medicare Risk Adjustment Overview and Documentation Guidance PDF
Transitional Care Management With Medication Reconciliation Post-Discharge Notice PDF
Urinary Incontinence Notice PDF

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The Pennsylvania Department of Human Services must make sure that everyone who is receiving Medical Assistance is still eligible by reviewing each person's information.

Here's what you need to do now

Copyright © 2013-2024 KEYSTONE FIRST VIP CHOICE. All rights reserved.

Last Update: Wednesday, April 17, 2019 9:52:25 AM

Coverage by Vista Health Plan, Inc. Independent Licensee of the Blue Cross and Blue Shield Association.

This site contains links to other internet sites. Keystone First VIP Choice (HMO SNP) is not responsible for the content of these sites. Please see Terms of Use, Privacy Notice, Third-Party Data Privacy and Educational Materials, and Potential for Contract Termination.

Keystone First VIP Choice is an HMO-SNP plan with a Medicare contract and a contract with the Pennsylvania Medicaid program. Enrollment in Keystone First VIP Choice depends on contract renewal. This information is not a complete description of benefits. Call 1-800-450-1166 (TTY 711), Monday through Friday, 8 a.m. – 8 p.m., from April 1 to September 30; or seven days a week, 8 a.m. – 8 p.m., from October 1 to March 31 for more information.

Out-of-network/non-contracted providers are under no obligation to treat Keystone First VIP Choice members, except in emergency situations. Please call our Member Services number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. You must continue to pay your Medicare Part B premiums, unless otherwise covered by your Pennsylvania Medicaid benefits.

Every year, Medicare evaluates plans based on a 5-star rating system.