American Specialty Health and its affiliates, ASH Plans, ASH Networks, etc. (ASH) employ a clinical procedure assessment process to evaluate diagnostic and therapeutic procedures utilized by ASH contracted providers in light of professionally recognized standards of practice, current scientific evidence, and consensus of appropriate experts.

To facilitate this process, ASH’s clinical management team has established the Technology Assessment Clinical Consensus Committee (TACCC). The purpose of TACCC is explicitly defined as:

To develop a set of criteria, definitions, and processes that will inform the clinical decision-making within American Specialty Health Affiliates Clinical Management system and elevate the level of rigor, precision, predictability and transparency of the ASHA clinical policy-making processes. Further, to apply these criteria, definitions, and processes in the evaluation of specific diagnostic and therapeutic procedures.

The TACCC is comprised of an integrated panel comprised of experts in clinical epidemiology, health services research, health care policy, the basic sciences, professional education, and private practice professions, whose role is to assess clinical literature and provide expert clinical opinion. Six of the nine standing TACCC panel members were chosen by ASH based on their depth of research experience within their respective professions and the other participants are three ASH clinical staff and 1-4 topic specific content experts (e.g. diagnostic radiology; biomechanics; or other areas of expertise as appropriate).

The recommendations of the TACCC’s formal consensus process are used by an ASH clinical quality committee, the Clinical Provider Review Committee, to develop and adopt guidelines, criteria, definitions, and processes to support clinical decision-making within ASH’s clinical management system. These criteria and processes support the evaluation of contracted and non-contracted and applicant provider performance related to the use of specific diagnostic and therapeutic procedures during the credentialing and re-credentialing processes, utilization management review, quality management case review and to monitor overall clinical quality activity on an ongoing basis between credentialing cycles.

The results of the process are published in the ASH Clinical Practice Guideline documents that are available to participating providers of American Specialty Health.