Divisions
Alliant | GMCF, also known as Georgia Medical Care Foundation (GMCF), continues to service our longstanding Georgia contracts through the divisions described below and organized around the functional needs of our customers.
Medicare Quality Improvement Organization of Georgia
As the Medicare Quality Improvement Organization of Georgia under contract with the Centers for Medicare & Medicaid Services (CMS), our industry experts coordinate large-scale
system changes and quality improvement projects to promote better care coordination, healthy lifestyles, and improved outcomes for Medicare beneficiaries. In conducting this work, Alliant | GMCF also partners with many other state agencies, local professional associations, health systems, and medical schools & universities to improve health care for Georgians.
QIO Contract Number: HHSM – 500-2011 GA 10C
Georgia Medicaid
Our Medicaid Division has continuously served this Georgia public program since 1972. The Division provides Utilization Management services to ensure
appropriate allocation of resources through evaluating the medical necessity and appropriateness of health services. This includes
prior authorization and concurrent & retrospective reviews; utilization trend analysis; and medical policy consultation.
The Division also provides Program Integrity services ensure program compliance and appropriate payments, including fraud & abuse
detection analysis; desk and onsite medical record reviews; onsite program compliance audits, surveillance and utilization review
studies and record reviews; and provider education to improve compliance. The Division also provides Quality Management & Improvement services focused
on improving the care and health of the Medicaid population. This includes quality improvement projects; program evaluation and consultation; HEDIS data collection and analysis; and provider education.