Projects - Precertification and Quality Assurance
In more than 30 years of service to state Medicaid programs, the West Virginia Medical Institute (WVMI) has developed proven processes to assure health plan dollars are spent as efficiently and effectively as possible. Among these are procedures for examining the necessity of care before it is delivered, and retrospectively analyzing records and claims data to detect unnecessary services and improper billing.
In collaboration with the West Virginia Medicaid program, WVMI is providing an array of pre-authorization and case management services including:
- Prior authorization of inpatient admissions
- Review of children’s psychiatric admissions to acute care and residential treatment programs
- Evaluation of long-term care placement
- Review of organ transplant services
- Medical necessity review of rehabilitation services for children
- Case Management
- Medical necessity review of in-home services paid for by Medicaid
Supplementing our Medicaid review experience is the review services we have provided as one of the nation's leading Medicare Quality Improvement Organization (QIO) contractors. WVMI has analyzed hundreds of thousands of medical records, developed proven techniques for identifying patterns of care, and worked with providers at both the individual and system level to bring about improvements in health care quality.
