Description
The Mississippi Division of Medicaid (DOM) is seeking to contract with a qualified and responsible Offeror to conduct External Quality Review (EQR) activities in compliance with applicable federal regulations. These activities are intended to support the Mississippi Coordinated Access Network (MississippiCAN) and the Mississippi Children’s Health Insurance Program (CHIP). The selected External Quality Review Organization (EQRO) will be responsible for analyzing and evaluating aggregated data concerning the quality, timeliness, and accessibility of services covered under Medicaid and CHIP, as delivered by Managed Care Organizations (MCOs).
• The EQRO will perform required and optional EQR activities in accordance with federal regulations and the most current or superseding guidance issued by the CMS.
• The EQRO will review and analyze reports submitted by MCOs, including call center audits, disenrollment surveys, encounter data completeness plans, and healthcare experience surveys.
• The EQRO will conduct annual provider satisfaction surveys and review quality management program descriptions and evaluations.
• The EQRO will provide summaries of reviews, findings, and recommendations to DOM.