INFO: Carequality Coverage

Understanding Carequality Information in the Outside Care Portal

 

The Outside Care Portal provides visibility into participant information shared through Carequality, a national health information exchange (HIE) network. This connection allows you to access additional records about a participant’s care that originate outside of your PACE organization.

 

Why You May Not See Certain Information
 

It’s important to understand that Carequality cannot guarantee full or consistent coverage of participant information. Several factors influence what data appears in the portal:

• Organization participation: Each external organization must choose to share data through Carequality. Participation is at the discretion of that organization.
• Participant consent: Even if an organization participates, a participant may provide consent at one site but not another. This affects whether their information flows into Carequality.
• Data submission: Some organizations may only upload certain categories of data. As a result, not all types of information may be available for every participant.

Because of these variables, the level of information in the Outside Care Portal will vary by both participant and organization.

 

How to Use Carequality
 

Carequality is a powerful supplement to your existing workflows, but it should not be considered a complete record of care.
 

• Do not replace faxing workflows: Existing faxing and communication processes with external provider organizations remain essential.
• Use as supplemental visibility: Carequality should be seen as a way to gain access to additional information about a participant’s care outside of your organization — information that you otherwise may not have visibility into.

 

Key Takeaway
 

Carequality expands access to outside records, but due to the variables of organizational participation, participant consent, and data submission, it cannot guarantee comprehensive coverage. Use it as a valuable complement to — not a replacement for — your existing workflows.