Qualidigm performs admission screening and utilization review services for Medicaid, commercial fee for service and managed care programs to evaluate the medical necessity, appropriateness and efficiency of the use of health care services, procedures and facilities under the provisions of the benefits.

Our utilization review services include admission screening and concurrent length of stay review as well as retrospective review for medical necessity and appropriateness of care in acute care hospitals, free-standing psychiatric and rehabilitation hospitals and nursing homes.

Our case management nurses review the outcomes of the admission and continued stay review processes, and manage the denial and appeals processes if necessary.

For more than two decades, Qualidigm has been providing utilization review services to help improve the quality and cost-effectiveness of care. Our nurse review staff have a combined 77 years of experience in providing utilization and quality of care reviews to hospitals, nursing homes and home care agencies.

Featured Work

Utilization Review for Rhode Island Medicaid Recipients

Utilization Review for Rhode Island Medicaid Recipients

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