Keeping members safe is something we all share responsibility for. The quality classification system helps us understand how serious a concern is and guides how quickly we need to act.
Level IV – Severe or systemic risk
Severe harm has occurred, or the issue represents a systemic failure that may put other members at risk. Urgent action and thorough review are required.
Level III – High risk
The issue has resulted in significant adverse effects or presents a dangerous or potentially life-threatening situation. These concerns require immediate escalation.
Level II – Moderate risk
There is a significant potential for adverse effects if the issue is not addressed promptly. Timely action helps prevent escalation.
Level I – Minimal risk
A quality issue exists, but there is minimal risk of harm to the member. These concerns follow standard reporting and resolution processes.
Level 0 – No quality issue
The concern does not meet quality criteria, but it is tracked for trends to help identify patterns over time.
Immediate jeopardy situations require immediate director notification and urgent response. These occur when:
Understanding these levels helps us communicate concerns clearly and act appropriately. High risk situations require immediate action, while lower-level concerns follow standard timelines. When in doubt, speak up. Working together keeps our members safe.
Provider Portal