Performs utilization review services for Rhode Island fee-for-service Medicaid recipients.

Challenge:

Unnecessary healthcare procedures, ineffective treatments and overlong hospitals stays are a few examples that lead to an overburdened health system and dissatisfied patients.

Solution:

Under contract with the Rhode Island Department of Human Services, Qualidigm performs utilization review services for Rhode Island fee-for-service Medicaid recipients. Our team of case managers evaluate the medical necessity, appropriateness and efficiency of the use of health care services, procedures in acute care hospitals, free-standing psychiatric and rehabilitation hospitals, and a hospital with a NICU.

Benefit:

Qualidigm’s high quality case management has resulted in decreased hospitalizations with a total savings of over $5.4M in four years.