IPRO Takes Over Rhode Island Hospital Review Activity

LAKE SUCCESS, N.Y., Oct. 27, 2020 /PRNewswire/ -- IPRO is now responsible for Medicaid acute care hospital utilization review (UR) in the state of Rhode Island, effective this month. Under the terms of a contract with Rhode Island's Executive Office of Health & Human Services (EOHHS), IPRO will oversee services provided by 12 hospitals and three healthcare systems across the state.

As the long-time Medicaid Review agent for the State of New York, IPRO reviews the cost and appropriateness of thousands of inpatient cases each year. Under the Rhode Island contract, IPRO will be responsible for screenings, concurrent review and retrospective analysis of Medicaid inpatient services. IPRO also will be responsible for prior approval of admissions, review of nursing home placement screenings and cases drawn from the state's Department of Corrections. The organization is taking over review activity from the state's previous contract holder, Qualidigm of Connecticut.

"Working collaboratively with EOHHS, we're committing to a straight-forward and seamless transition of hospital oversight from the previous contractor to IPRO," according to IPRO's Senior Vice President and Chief Operating Officer Harry M. Feder. "We will avoid disruptions for hospitals and physicians and will keep authorization telephone numbers the same," he said.

IPRO already has significant experience in Rhode Island. IPRO has provided external quality review services to Rhode Island since 2003, providing oversight of the state's Medicaid managed care plans.

Technical and logistical questions from providers should be directed to Wendy P. Ferguson, IPRO Senior Director of Review, at [email protected] or 516-209-5378/5592.

IPRO is a national, not-for-profit healthcare organization that works with government agencies, providers and consumers to implement innovative programs that bring policy ideas to life.  IPRO does this by making creative use of clinical expertise, emerging technology, data solutions, and diverse marketplace experience to make the healthcare system work better. Incorporated in 1983, IPRO is one of the nation's largest and most experienced healthcare quality improvement organizations.  IPRO works in partnership with clients to achieve their goals of improved, equitable, and cost-effective healthcare.

SOURCE IPRO

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http://www.ipro.org