Effective November 1, 2007, Qualis Health, a non-profit healthcare Quality Improvement Organization (QIO), will begin providing a broad range of services to the Nebraska Medicaid program. Our mission is to generate, apply, and disseminate knowledge to improve the quality of healthcare delivery and health outcomes. We strive to improve the health of individuals and populations based on a set of core values that emphasize integrity, professionalism, collaboration, and stewardship.
For more than 20 years, Qualis Health has successfully administered Medical Utilization Review programs through numerous public and private sector contracts. In our collaboration with the Nebraska Medicaid program, we will work with providers and the Department of Health and Human Services to perform the following services:
- Prior-authorization Reviews
- Retrospective Reviews
- Pre-admission & Concurrent Review of Acute Inpatient Rehabilitation
- Reconsiderations
- Appeals
- Focused Case Reviews
- External Quality Review of Managed Care Organizations
- Special Projects
To assist in your utilization review process, we have assembled educational resources, tools, and information on this web site. We include provider access to iEXCHANGE®, a secure web-based, HIPAA-compliant utilization management processing system. This application is intuitively designed, requires minimal training, and improves communication between all parties during the preauthorization process.
On behalf of Medicaid recipients and their families, we will work collaboratively with the Nebraska Department of Health and Human Services, to help them achieve their mission “To create and sustain a unified, accessible, caring and competent health and human services system for each Nebraskan that maximizes local determination to achieve measurable outcomes. To this end, the state will work in partnership with communities and their public and private sector entities."
