External Quality Review

IPRO staff has extensive experience in all mandated and optional activities outlined in the External Quality Review (EQR) regulations, and offers states customized programs based on a diverse range of services, including:

• Validation of performance improvement projects.
• Focused clinical studies.
• Procedures and automated processes for encounter data validation, analysis and reporting.
• Technical assistance to states and managed care organizations in reporting and analyzing encounter data.
• Automated data collection tools and medical record abstraction and tracking systems, incorporating extensively field-tested tools to enhance project management, reduce cost and provide quality control.
• Quality improvement program development and administration.
• Assessment of Managed Care Organization (MCO) internal administrative processes to ensure compliance with state and federal requirements.
• Educational programs.
• Calculation and validation of performance measures including HEDIS® Compliance Audits™.
• Provider satisfaction and access and availability surveys.
• Member satisfaction surveys.
• State-level and health plan-specific technical reports.
• Individual case review.
  

IPRO serves as the independent External Quality Review Organization (EQRO) for Pennsylvania (since 2000), New York (since 1987), Rhode Island (since 2003), Kentucky (since 2005) and Nebraska (since 2007).

Through these services, IPRO currently evaluates health care provided to more than 2.5 million Medicaid recipients enrolled in more than 100 Managed Care Organizations.

IPRO has more than 15 years experience in External Quality Review relating to the Medicaid managed care population in multiple states.

For more information about External Quality Review, contact us.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). NCQA HEDIS® Compliance Audits™ is a trademark of the National Committee for Quality Assurance (NCQA).