TO: All Border and In-state Hospital Providers
Effective November 1, 2013, Qualis Health will be the Quality Improvement Organization (QIO) for inpatient hospital quality review activities. Please be prepared to furnish inpatient quality review staff contact(s) and any other information/documents that may be requested by the Qualis Health representatives.
Providers should note the following:
· Medical records requested by the previous contractor, AFMC, that were not provided to them by October 31, 2013 will not be required to be submitted to Qualis Health.
· Hospitals are required to submit a Utilization Review Plan and a Medical Care Evaluation Study annually and these will be requested by Qualis for CY 2013.
· Requests for medical records for quarterly retrospective review of inpatient admissions for dates of service April 1, 2013-September 30, 2013 will be sent out January 1, 2014.
· All admissions must meet Alabama Medicaid Adult and Pediatric (SI/IS) Inpatient Care criteria.
Providers with questions may contact Jan Sticka, Program Manager, Inpatient Hospital QI Program at jan.sticka@medicaid.alabama.gov or by phone 334-353-4151 or Karen Watkins-Smith, Associate Director, Clinics/Mental Health Programs at karen.watkins-smith@medicaid.alabama.gov.