EXTERNAL QUALITY REVIEW ORGANIZATION

The contract is for external quality review organization services, which includes activities such as external quality review, development and validation of performance improvement projects, quarterly analysis of pre-service denial, appeals, and grievance reports, and encounter data validation. The contract has a term of one year, with an option to renew for an additional year. The contract value is estimated to be $700,000. The vendor, Qlarant Quality Solutions, Inc., will provide these services to the West Virginia Department of Health and Human Resources, specifically the Bureau for Medical Services. Some of the key services include: • External quality review activities • Development and validation of performance improvement projects • Quarterly analysis of pre-service denial, appeals, and grievance reports • Encounter data validation • Annual technical reports • Ad hoc reporting services • Ad hoc technical assistance • Quality rating system services The contract also includes a certification from the Centers for Medicare & Medicaid Services, which designates Qlarant Quality Solutions, Inc. as a Quality Improvement Organization (QIO)-like entity.