Seattle - Qualis Health has been awarded a contract by Nebraska's Department of Health and Human Services (DHHS) to provide the state's Medicaid participants with peer review and external quality review organization services. The contract is being administered by staff in Qualis Health’s Lincoln, Nebraska office, which is headed by program manager Cynthia Treffer, RN, and medical director Dale Michels, MD.
Qualis Health, which has broad expertise evaluating and improving healthcare services for Medicaid clients in four other states, will provide a statewide quality and utilization control program for services supplied to Nebraska Medicaid participants enrolled in fee-for-service systems.
Qualis Health will conduct retrospective reviews of inpatient hospital services; prior authorizations of inpatient rehabilitation, select surgical procedures, and out-of-state services; quality reviews; focused reviews; special projects; and other services. In addition, Qualis Health will also supply an annual external and independent quality review of the services provided by the state’s one managed care organization.
“Qualis Health is excited to partner with the state of Nebraska and its provider community to assist Medicaid participants in receiving the medically necessary and high quality care that they need,” said Jonathan R. Sugarman, MD, MPH, Qualis Health's president and chief executive officer. “We believe that our services will aid Nebraska in managing its healthcare resources, while also assisting DHHS in achieving its mission to create and sustain a health and human services system for each Nebraskan.”
Qualis Health, which is accredited by URAC in health utilization management, case management, and independent review, has provided comprehensive care management services for more than 30 years to clients such as employers, health plans, trusts, third-party administrators, workers' compensation organizations, and government agencies. Qualis Health currently covers nearly 4 million lives nationally with its suite of care management products.
