eQHealth Solutions is the Medicaid Quality Improvement Organization (QIO) that is responsible for conducting retrospective reviews of services provided to Medicaid beneficiaries. The Arkansas Department of Human Services, Division of Medical Services, has contracted with eQHealth Solutions to complete retrospective review of services delivered to Medicaid beneficiaries by doing the following:
(1) Determine if those services are delivered in accordance with the plan of care and conform to generally accepted professional standards.
(2) Evaluate the medical necessity of services provided to Medicaid beneficiaries.
(3) Evaluate the clinical documentation to determine if it is sufficient to support the services billed during the requested period of authorized services.
(4) Safeguard the Arkansas Medicaid program against unnecessary or inappropriate use of services and excess payments in compliance with 42 CFR 456.3(a).