Ensuring Medically Necessary and Appropriate Care

IPRO Ensures Medically Necessary and Appropriate Care by:
Ensuring Integrity of Government Health Programs
Medicaid Managed Care Oversight
Person- and Caregiver-centered Care

Ensuring Integrity of Government Health Programs

IPRO offers a comprehensive suite of solutions to help state and federal agencies ensure appropriate spending of Medicaid and Medicare funds while protecting the health and welfare of their beneficiaries.

Medicaid Managed Care Oversight

IPRO is a Federally qualified External Quality Review Organization (EQRO), with Medicaid managed care oversight contracts in seven states and a U.S. territory. Our Managed Care Department has extensive experience in implementing protocols and related assessment activities as they pertain to behavioral, as well as physical health. We are an NCQA-licensed HEDIS Compliance Audit™ organization.

  • Medicaid External Quality Review (EQRO) Activities
  • Performance Improvement Projects
  • Performance Measure Validation
  • MCO Care Management
  • Annual Compliance Reviews
  • Encounter Data Validation
  • HEDIS® Compliance Auditing
  • Focused Quality Studies
  • Surveys
  • Pay-for-Performance Data Aggregation

Person-and Caregiver-centered Care

From independent reviews of denials of care, appeals of non-coverage and complaints of quality of care; to implementing interventions that increase patient skills and confidence in the management of their health problems, IPRO works to promote patient awareness of their rights and responsibilities in participating in their own healthcare and in receiving the right care, at the right time.

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

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