Medicaid Fee-for-Service Utilization Review Program
MPRO has provided prospective and retrospective utilization review services for the Medicaid Fee-for-Service (FFS) population for the Michigan Department of Community Health (MDCH) since 1988.
MPRO provides utilization review and audit services for MDCH.
The Prior Authorization Certification Evaluation Review (PACER) Program
PACER conducts elective inpatient admissions, inter-hospital transfers, readmissions and rehabilitation admission and continued stay reviews
Learn more about PACER
The Emergency Room/Outpatient and Inpatient Audit
The audits are a targeted review program that evaluates a sample of medical records for a specific provider. MDCH randomly selects providers from the emergency room/outpatient setting and the inpatient acute care setting. MPRO’s registered nurses and a support team make arrangements to scan the provider’s medical records in accordance with MDCH guidelines. An audit is conducted of the scanned records at MPRO’s office and a report is submitted to MDCH upon the completion of the audit. MDCH notifies the provider of the audit results.
NEW, effective June 1, 2006 Statewide Utilization Review Program
This program evaluates randomly selected medical records from each acute care provider in Michigan. The provider is sent a case listing of medical records that need to be submitted to MPRO. Upon receipt of the medical records, the cases are evaluated for the medical necessity of the inpatient admission and the appropriateness of DRG coding. Currently, this program’s focus is to educate Michigan providers on MPRO’s review findings.
