Our work advances healthcare and improves health for people in Alabama through our expertise in utilization management and quality review. From our Birmingham office, we collaborate with the Alabama Medicaid Agency (AMA). Our staff is composed of Alabamians who provide services within their own community to support the needs of Alabama residents. We are privileged to provide this vital work for the state of Alabama.
Services We Provide for the AMA
Our current work in Alabama includes medical and quality review for the AMA for the following healthcare services, equipment and supplies provided to Medicaid recipients:
- Hospice reviews, including admission and concurrent review
- Institutional admission review, including review of nursing homes, post-extended care, swing beds and inpatient psychiatric facilities
- Prior authorization review, including review of durable medical equipment, home health, transportation, occupational and physical therapy, surgical procedures and inpatient and outpatient hospital services
- Appeal review, including informal review and fair hearings
- April 2014: We have created a provider manual for inpatient hospital quality assurance. You can also find it on the Provider Resources page.
- As of November 1, 2013, Qualis Health has begun a new scope of work with the Alabama Medicaid Agency for hospital inpatient quality reviews.
In January 2014, Qualis Health will send requests for medical record documentation for quarterly retrospective reviews of inpatient admissions. The first review timeframe will cover dates of service from April 1, 2013, through June 30, 2013, and July 1, 2013, through September 30, 2013.
We will also send requests for your Hospital Utilization Review Plan (UR Plan) and Medical Care Evaluation (MCE) study.