Solutions for States.
Results for Managed Care Organizations.
Qlarant is a designated, independent External Quality Review Organization (EQRO) helping state agencies meet federal regulations for assessing Managed Care Organizations (MCOs). With our national subject matter experts, data analysts and proven processes, we know how to partner with you to improve performance.
Our Qlarant team is experienced in identifying opportunities, recommending interventions and improving outcomes — with a staff comprised of clinicians/nurses, analysts, statisticians, epidemiologists and technical writers. Certifications include NCQA-Certified HEDIS® Compliance, Health Care Quality, Six Sigma, Project Management Professionals and Professional Coders.
Quality. Clarity. Opportunity.TM
We use data analysis, audits and technical assistance to improve MCO and network performance — while helping you manage your costs. As a QIO-like organization, we’ve worked with states and MCOs in virtually every area of operations and management, showing real results. Here are just a few of the services we’ve provided:
- Mandatory performance measures: reviewing for compliance, validating performance measures and performance improvement projects (PIPs)
- Encounter data validation for MCO contracts
- Dashboard development of critical metrics and Plan/Network Comparisons
- Readiness reviews for new MCOs
- State system monitoring for MCOs (appeals, claims, provider management, etc.)
- Independent Waiver Assessments
- Customer and provider surveys
- Assistance with developing required quality strategies
- Provider enrollment compliance
- Technical assistance for your quality improvement programs and teams
- Preparation of technical and annual reports
Managed Care Services
Compliance & Performance Measures
You can count on Qlarant’s outstanding track record as an EQRO. We’ve evaluated more than 60 Managed Care Organizations nationwide for compliance and performance measures.
Performance Improvement Projects
In addition to mandatory validation, Qlarant can help you conduct PIPs across a spectrum of topics ranging from behavioral health to diabetes control, from dental services to asthma.
Qlarant’s teams go wherever needed to meet in person with individuals receiving services in their environment. Besides making sure your enrolled beneficiaries are receiving the services they deserve, we can help you determine how best to improve their quality of life.
Audits and Provider Reviews
Qlarant teams can conduct onsite and desk MCO audits, MCO network provider audits and provider reviews and interviews, all to ensure and enhance compliance. We can also look at administrative fees, such as allocation of management fees or improper allocations of non-allowable costs.
Qlarant’s library of algorithms can examine the services of MCO network providers to reveal outliers, trends, ordering/referring physician patterns, overutilization of services, duplication and more. Our outcomes-based predictive modeling tools and data analysts deliver meaningful insights and results.
With a keen eye, we review admissions, duration of stay and professional services provided. We also evaluate the medical necessity of those services and advise our clients about their most efficient use.