CIMRO - MANAGED CARE OVERSIGHT

managed care oversight image

LINKS:
Focused Quality Studies
Special Projects
Medicare
Leadership/Contacts

CIMRO provides oversight of managed care organizations through quality assurance activities such as onsite assessment, evaluation of reporting systems and analysis of network adequacy. Medical evaluation studies are also reviewed to ensure they are relevant in clinical care or service delivery, produce meaningful outcomes and result in appropriate interventions to improve the quality of care available to managed care beneficiaries.

Medical record samples are also reviewed to assess the overall quality of care and compliance with medical standards, and to evaluate the legibility, accuracy, and completion of documentation of the care provided. Additional managed care oversight services include physician credentialing, HEDIS data collection and satisfaction/member surveys.