We assess what’s been delivered — and discover new opportunities.
With Qlarant, you have a Utilization Management partner you can truly rely on for expertise, insight and results, all to help you find opportunities for the most effective, cost-efficient care. Our clients count on us to examine and ensure that:
- Medical services are authorized when medically necessary
- Hospital or inpatient stays are authorized only when they can’t be effectively provided on an outpatient basis or in another type of facility
- Services for individuals in a long-term care facility, chronic hospital or in a community-based program are medically authorized
- Services for Medicaid recipients meet recognized standards of quality
- Abuses of utilization or payment are identified and reported to the appropriate authorities
The Qlarant team is dedicated to protecting your fiscal and clinical integrity. We’re on a mission to improve health for the individuals you serve, for whatever services you provide: home health, skilled nursing, physician, dental, and inpatient and outpatient hospital services.
What do you need to address? What’s working and what can be improved? Our people employ solutions from predictive modeling to face-to-face interviews — all to manage and improve utilization for your organization. Our expert team includes registered nurses, medical directors, certified coders, business analysts, statisticians, data analysts and many other professionals.
Better utilization management is in our DNA. As part of the IPRO QIN-QIO Network, Qlarant is a designated QIO-like organization tasked with fostering better utilization and reducing costs through improvement. In the District of Columbia, we’ve seen significant outcomes in better care, better health and lower costs (the goal of Triple Aim), from improved cardiac population health to reducing re-hospitalization rates. We can apply that expertise to improve your organization and outcomes, too.
Utilization Management Services
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Medical Reviews
The Qlarant team performs medical reviews, evaluating health care service delivery and outcomes. Our reviews cover services such as personal care and family planning, home health, nursing facility, physician, dental and inpatient and/or outpatient hospital services.
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Performance Improvement Projects (PIPs)
In addition to mandatory validation, Qlarant can also help you conduct PIPs across a spectrum of topics, ranging from behavioral health to diabetes control, from dental services to asthma.
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Utilization Reviews
With a keen eye, we review admissions, duration of stay and professional services provided. We also evaluate the medical necessity of those services and more importantly, deliver strategies for improvement.
