Evaluating the Quality and Medical Necessity of Fee-for-Service Medicaid Benefits
Part of ensuring Fee-for-Service (FFS) Medicaid operates as intended by monitoring the quality, safety, and value of care patients receive. MetaStar’s expert team of nurse reviewers evaluates the quality and medical necessity for inpatient hospital care for members receiving FFS Medicaid benefits. Additionally, the software development team creates secure web-based tools to gather results or reviews, providing data reports at both provider and state level. Quality issues and potential overpayment concerns are referred to the Wisconsin Department of Health Services (DHS) to potentially recover funds.
