Annually, the Centers for Medicare and Medicaid Services (CMS) requires states having a Medicaid managed care program to review the quality of its managed care entities. The states must hire an independent external quality review agency (EQR) to perform this task. In 2012, Burns and Associates hired Lawrance Policy Consulting to be its Indiana-based women business enterprise subcontractor. 

Solution 

We were tasked with various projects over the years including prior authorization audits, provider onsite interviews, managed care entity interviews, policy and procedure audits, data reporting manual updates, encounter claim process mapping, performance improvement project reviews and HEDIS measure reviews. We would gather data from desk reviews, claim data queries as well as provider, member and staff interviews.  

Results/Outcome 

We would produce an annual report with data results and recommendations that would be presented both to the Indiana Office of Medicaid Policy and Planning and CMS. 

https://www.in.gov/fssa/ompp/quality-and-outcomes-reporting/  (2012-2019)