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.
- Audit Integrity Medicaid Contractor
- Utilization Review
- Medicaid Retrospective Review
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
- 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.
- Independent Review of Appeals (IRO)
- Patient Empowerment (Chronic Disease Wellness Programs)
- Pre-Admission Screening and Resident Review
- Patient-Centered Medical Home (Medicaid)
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).