Designations & Accreditations

Quality Improvement Organization Designation | Centers for Medicare & Medicaid Services
We have continuously served as the Quality Improvement Organization (QIO) for Georgia since the program’s inception. Additionally, QIOs can perform two different, but similar, activities addressed in two separate sections of Federal Medicaid law.

First, section 1902 (a)(30)(A) of the Social Security Act (the Act) requires that State Medicaid Agencies provide methods and procedures to safeguard against unnecessary utilization of care and services and to assure "efficiency, economy and quality of care." Under section 1902 (d), a State can contract with a QIO or QIO-like entity to perform medical and utilization review functions required by law. The contracts must be consistent with the QIO legislation. Section 1903 (a)(3)(C) of the Act specifies that 75% Federal Financial Participation is available for State expenditures for the performance of medical and utilization reviews or external quality reviews by a QIO, or by entity, which meets the requirements of section 1152 of the Act (i.e., "QIO-like entity").

Second, section 1902 (a)(30)(C) of the Act requires the performance of an annual, independent, external review of the quality of services furnished under each State contract with a Managed Care Organization (MCO) that is governed by section 1903 (m) of the Act. Section 1902 (a)(30)(C) further specifies that only three types of organizations are permitted to perform this review: 1) a QIO that has a contract with the Secretary to perform Medicare reviews; 2) an organization which is determined by the Secretary to meet the requirements for qualifying as a QIO contained in section 1152 of the Act (i.e.; a QIO-like entity); and 3) a private accreditation body.

URAC Utilization Management and Core Accreditation | URAC

We have held URAC Health Utilization Management and Core Accreditation since 1997. URAC is the largest accrediting body for health care. To receive accreditation, applicants must undergo a rigorous vetting process to ensure that only appropriately trained, qualified clinical personnel conduct and oversee the utilization review process; that a reasonable and timely appeals process is in place; and that medical decisions are based on valid clinical criteria. URAC Health Utilization Management Accreditation provides assurance to patients, providers, purchasers, regulators and employers that the practices of the organization performing these services are fair and equitable to all parties.

ISO 9001 Certification| International Organization for Standardization

In 2008, we earned the ISO 9001 designation, an international standard for Quality Management. It ensures that our quality management system consistently provides products and services that meet customer and regulatory requirements, aims to enhance customer satisfaction, and includes processes for continual improvement.