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MPRO Corporate Home: Services: External Quality Review Services

MPRO External Quality Review (EQR) Services

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MPRO EQR Qualifications

  • Federally designated Quality Improvement Organization (QIO) for over 20 years
  • Nine years of continuous EQR experience
  • EQRO contracts in multiple states
  • National Committee for Quality Assurance (NCQA) staff expertise
  • Significant managed care expertise – Medicaid, Medicare, commercial

Services Offered:

MPRO has extensive experience in External Quality Review (EQR) activities, as well as in designing and implementing customized programs to meet our clients’ needs. State agencies can derive tremendous value from MPRO’s EQR services - awareness of your Medicaid managed care challenges and potential solutions can lead to greater efficiencies, cost-savings, and ultimately, higher customer satisfaction. MPRO’s EQR services include, but are not limited to:

  • Assessment of managed care organization (MCO) compliance with state and federal regulations
  • Validation of performance improvement projects (PIPs)
  • Validation of encounter data
  • Abstraction of medical records
  • Review and assessment of state quality strategy
  • Development of data collection tools
  • Conduct of focused clinical studies (e.g., EPSDT, prenatal care, asthma, STDs, colorectal cancer, breast cancer, diabetes, otitis media, CSHCN, and others)
  • Validation of performance measures
  • Administration and validation of surveys
  • Review of care treatment plans, access to women’s health services, cultural sensitivity, and advance directives
  • Preparation of Annual Technical Reports (ATRs)
  • Provision of technical assistance to states and MCOs

Qualified Staff

MPRO staff have extensive experience with all aspects of mandated and optional EQR activities and have a proven track-record of exceeding customer expectations in multiple states.

Our highly qualified staff includes NCQA surveyors, seasoned managed care professionals, and adjunct university faculty members whose experience span the past two decades of implementing quality improvement, utilization management, and disease management programs. Our team has many years of Medicaid managed care operations and behavioral health experience, and has access to an established network of experts in various EQR-related areas.