Effective July 1, 2007, Qualis Health, a nonprofit healthcare Quality Improvement Organization (QIO), will begin providing a broad range of services to the South Carolina Medicaid program. Our mission is to generate, apply, and disseminate knowledge to improve the quality of healthcare delivery and health outcomes. We strive to improve the health of individuals and populations based on a set of core values that emphasize integrity, professionalism, collaboration, and stewardship.
For more than 20 years, Qualis Health has successfully administered Medical Utilization Review programs through numerous public and private sector contracts. In our collaboration with the South Carolina Medicaid program, we will work with providers and the Department of Health and Human Services to perform the following services:
- Preauthorization Reviews for specific surgical procedures
- Retrospective Reviews of hospital stays
- Quality Assurance (QA) of Behavioral Health Institutions of Mental Disease/Residential Treatment Facilities
- External Compliance Monitoring of Medical Homes
- Quality Assurance (QA) Level of Care Waiver and Special Project Studies
To assist in your utilization review process, we have assembled educational resources, tools, and information on this website. We include provider access to iEXCHANGE®, a secure web-based, HIPAA-compliant utilization management processing system. This application is intuitively designed, requires minimal training, and improves communication between all parties during the preauthorization process.
On behalf of Medicaid recipients and their families, we will work collaboratively with the South Carolina Department of Health and Human Services, to help them achieve their mission “to manage the Medicaid program to provide the best healthcare value for South Carolinians.”
We welcome your feedback about improving this website or our program support to you. For comments and suggestions that do not include patient’s personal health information, please contact:
Barbara Excell
Director, Medicaid Services Central/East
(803) 739-2758
barbaraex@qualishealth.org
