Public Reports

As stewards of the public trust and funds, PrimeWest Health is held accountable for the quality of the health care services we cover for our members. As such, audits occur on a regular basis and results are made available to the public. To learn more about audit standards or to see recent audit reports, click on the links below.

Annual Technical Report (ATR)
This report is the External Quality Review Organization's (EQRO) assessment of State and Federally mandated activities related to the unifying framework: structure, process, and outcomes. This framework serves as the foundation for the EQRO's recommendations to help organizations maintain and improve timeliness, quality, and access to health care services. The assessment consists of an inventory of activities and programs set forth in the Minnesota Department of Human Services/Managed Care Organization Contract and the Balanced Budget Act (BBA).

Consumer Assessment of Healthcare Providers and Systems (CAHPS^®)¹ Survey and Medicare Advantage Prescription Drug Plan (MA-PD) CAHPS Survey
The CAHPS Survey measures members' satisfaction with their care in areas such as claims processing, customer service, and getting needed care quickly.

Health Outcomes Survey (HOS) for PrimeWest Senior Health Complete (HMO SNP)
The HOS survey is the only patient-reported outcomes measure in Medicare managed care. A baseline and two-year follow-up survey are used to categorize each participating member’s physical and mental health status as better, the same, or worse than expected, taking into account risk adjustment factors.

Annual Report
The Annual Report is sent to members each year. It is an overview of PrimeWest Health events, quality initiatives, and financial information from the past year.

Health Record Reviews/Site Visit Reports
PrimeWest Health performs regular Health Record Reviews and Site Visits at provider locations. These reports provide the results of the completed audits and site visits.

Quality Assurance Plan
This document presents the written Quality Assurance Plan and describes the PrimeWest Health Quality program. Our Quality Assurance Plan was developed in accordance with State and Federal requirements as well as National Committee for Quality Assurance (NCQA) standards.

In addition to the Quality Assurance Plan itself, our Utilization Management Plan and Credentialing Plan contain further descriptions of our Quality program.

Model of Care Summary
The Model of Care is an overview of PrimeWest health’s written processes, including how we ensure quality, measure interventions and goals, coordinate services, and communicate between departments.

Prior Authorization Services List and Prior Authorization Metrics Report
To comply with the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule, Title 42 Code of Federal Regulations (CFR) Part 438.210 (f), and MN Stat. Chap. 62M, PrimeWest Health is required to annually report aggregated prior authorization (Service Authorization) metrics on our website. Specifically, this includes a list of all medical items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests received electronically for those items and services (e.g., approvals, denials, etc.) over the previous calendar year.

Reasons for prior authorization denials include, but are not limited to, the following:

• Patient did not meet prior authorization criteria
• Request was not medically necessary
• Request was not a covered benefit

Publicly reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes, and enables providers to evaluate payer performance. In addition, metrics can be used to compare plans, programs, and payers.

¹CAHPS^® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ)

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Updated_03/25/2026