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Qualis Health Wins Wyoming Medicaid Contract for DME Review

December 16, 2015

Two-year contract begins January 1, 2016, to assure appropriate utilization of durable medical equipment

Seattle, WA—Qualis Health has signed a contract with the Wyoming Department of Health Division of Healthcare Financing, providing its expertise in utilization management to advance healthcare and improve health for people in Wyoming. Beginning January 1, 2016, Qualis Health will implement prior authorization and retrospective review of durable medical equipment (DME) for Wyoming Medicaid clients to minimize inappropriate utilization while assuring that care is tailored to the needs of enrolled Wyoming residents.

The Wyoming Medicaid program serves approximately 88,000 eligible individuals, and spent $7.6 million on DME, prosthetics, orthotics and supplies in 2014—a 20% increase over the past five years, when the number of enrolled recipients increased by only 6%. Qualis Health's clinical review of DME services and claims ensures that prescribed equipment is appropriate to meet the needs of each client.

"We look forward to working with Qualis Health to help us assure that the Wyoming Medicaid program minimizes inappropriate utilization while providing for optimum services for our clients," said Amy Buxton, Provider Services Manager of the Wyoming Department of Health Division of Healthcare Financing. "This partnership supports the Department's mission to promote, protect and enhance the health of all Wyoming citizens."

"At Qualis Health, we strive to contribute to improving value in the healthcare system by ensuring the delivery of high-quality clinical services at a reasonable cost," said Jonathan Sugarman, MD, MPH, President and CEO of Qualis Health. "We look forward to assisting the Wyoming Department of Health to accomplish its strategic goals of improving health outcomes and strengthening program integrity."

Qualis Health also currently provides utilization management, quality review and population health management services for the Alabama, Alaska, Arkansas, District of Columbia, Idaho, New Mexico and Washington State Medicaid agencies.

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(206) 288-2458