The standards provide a framework for implementing best practices to:

• Apply a QI process to improve key operational areas.
• Structure cohesive population health management functions.
• Maintain an adequate practitioner network and access to care.
• Organize efficient utilization management processes.
• Establish timely and accurate credentialing and recredentialing processes.
• Adhere to a consistent process to recognize members’ rights and responsibilities.
• Connect members to health risk assessment and pharmacy benefit information.
• Meet Medicaid service requirements.