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Quality Improvement

Meridian’s Quality Improvement Program focus ensures members receive high-quality, medically appropriate, and cost-effective healthcare through strong provider partnerships.

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HEDIS® Resources and P4P Program

Published semi-annually, the HEDIS Quality Reference Guide details HEDIS measures and coding requirements to support accurate performance reporting in accordance with NCQA technical specifications.

Download our HEDIS Pocket Guides with the most frequently used codes for pediatric and adult measures.

Our Pay for Performance (P4P) program offers incentives to contracted providers who deliver essential preventive services to members.

Use the Meridian secure provider portal to view updated performance data, target percentile status, and payments earned year to date.

EPSDT Provider Toolkit

The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program is Medicaid’s federally mandated comprehensive and preventive health program for individuals younger than 21 years old.

Providing Quality Care: Key Information

Get Providing Quality Care resources to support high-quality care delivery, such as:

  • Appointment access standards
  • Member language, demographics, and language assistance resources
  • Utilization management overview
  • Care management overview and referral information
  • Annual member experience and provider satisfaction survey details
  • Member rights and responsibilities

Clinical Practice Guidelines

Find evidence-based guidelines adopted by Meridian’s Quality Improvement Committee on the Clinical Practice Guidelines page.

Quality Education Monthly Webinars

Attend and participate during our monthly quality education webinars. Email ILHEDISOPs@mhplan.com to be added to the distribution list.

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Key Quality Initiatives

Find high-value Quality Improvement Program resources that can make a meaningful difference with your partnership.

For women at average risk of breast cancer, routine mammograms beginning at age 40 make a lifesaving difference by detecting breast cancer at its earliest, most treatable stages. In 2025, the Breast Cancer Screening (BCS-E) HEDIS measure was updated to encompass women ages 40-74.

Support patients by referring them to an in-network mammogram facility in their community and remind them about rewards they can earn for completing this important screening.

Timely and coordinated care is critical to the safety and overall well-being of members with behavioral health challenges. For providers, it’s also an essential measure of healthcare quality that impacts several HEDIS measures.

Visit our Behavioral Health Provider Resources page for details on how to refer members to Meridian’s behavioral health care management team. Find behavioral health providers using our Find a Provider tool and connect members to telehealth services designed to meet their unique needs.

Opioid use disorder (OUD) increases the risk of overdose, death, avoidable acute care utilization, and blood-borne infections. Early diagnosis, timely access to Medication-Assisted Treatment (MAT), and coordinated care can reduce risk, improve treatment engagement, and help address disparities.

Review Meridian’s resource for strategies and tools to support sustained recovery.

Studies have found that self-measured blood pressure monitoring is associated with better hypertension control. Home blood pressure monitors are a covered benefit for members who need them. Bookmark our list of in-network durable medical equipment (DME) providers that deliver blood pressure monitors to patients’ homes.

The transition from pediatric to adult care is a high-risk period that can disrupt continuity of care and affect long-term health outcomes. As responsibilities shift from parents/guardians to young adults, many patients lose connection to care. Studies find that 1 in 4 young adults experience a care gap of at least one year.

Review Meridian’s resource for tools to help prepare patients for the transition to adult care, which can support performance across numerous HEDIS measures.

  • Preparing Adolescents for Transition to Adult Care (coming soon)

Meridian encourages providers to refer children for an initial dental visit by age 1 and establish an ongoing dental home to support preventive oral health care. Review our provider notice for details.

The providers in the spreadsheet below can render Oral Evaluation, Dental Services (OED) for Illinois Meridian members ages 0–2. Use this resource to connect members to dental providers that serve infants and toddlers.

Please note: This is not a comprehensive list but represents a sample of providers identified as serving members ages 0–2. Before making a referral, please verify that the provider accepts Meridian patients.

For a complete directory of participating dental providers, direct members to Meridian’s Find a Provider tool.