What is a Potential Quality Issue?
A potential quality issue is a suspected deviation from provider performance, clinical care, or outcome of care which requires further investigation to determine if an actual quality of care concern exists.
Purpose: To provide a systematic method for the identification, reporting, and processing of a potential quality issue to determine opportunities for improvement in the provision of care and services to PHC members and to direct the appropriate actions for improvement based upon outcome, risk, frequency and severity.
Click here for Peer Review and Investigation Policy
Click here for Potential Quality Issue Referral Form
Click here for Frequently Asked Questions (FAQs)