Our experienced clinical reviewers and performance improvement experts are committed to a fair and impartial care review process that benefits both consumers and providers. As a team, we share your commitment to quality care and timely access to health care services.
Our tenured clinical reviewers and performance improvement experts are committed to a fair and impartial care review process that benefits both patients and physicians. As a team, we share your commitment to quality care and timely access to health care services.
As a URAC-accredited Independent Review Organization (IRO) and federally designated External Quality Review Organization (EQRO), KFMC offers a range of health care quality review and audit services. We work with federal and state agencies and health care organizations across the Midwest and nationally. We provide independent and unbiased review of health care information to help states and health care organizations transform their care delivery systems. Our highly skilled and credentialed professionals offer objective recommendations to help ensure everyone has access to high-quality, timely care.
This national gold-standard accreditation validates KFMC’s commitment to a fair and impartial medical review process that benefits both patients and physicians.
This federal designation authorizes KFMC to analyze and evaluate aggregate information on the quality, timeliness, and accessibility of health care services that a managed care plan, or its contractors, furnishes to Medicaid consumers.
While ultimately improving health outcomes for patients, our proven approaches to clinical care optimization and health services review help organizations achieve greater operational consistency and enhanced performance. Our audit and review services include:
At KFMC, we find and implement better ways to help health care organizations perform at higher levels, improving health outcomes for everyone. Contact us today to learn more about the services we provide as your health improvement partner.
| KDHE, Division of Public Health, Bureau of Family Health: Maternal Mortality Abstraction and Review Services | Facilitate the activities of the Kansas Maternal Mortality Review Committee (MMRC), including chart abstraction and assessment, presentation of case findings, and facilitation of discussion and the development of recommendations from the MMRC. |
| KDHE, Division of Health Care Finance: Third-Party Review of Denied Medicaid Claims | Provide independent, third-party review determinations for Kansas Medicaid managed care claims that have been denied payment or denied services and the member/provider has exhausted the internal appeals process with the MCO. |
| KDHE: Kansas EQRO | Provide external quality review services to ensure access, quality, and timeliness of care for KanCare members. Using the federally mandated CMS EQR protocols, KFMC conducts a review of the managed care organizations and aggregate-level information and validates MCO-collected and submitted performance measures and performance improvement projects. |
| Individual Hospital/Health System/Practice Contracts*: Review Services | Provide independent and objective quality-of-care reviews for standard-of-care cases identified and referred to KFMC by individual provider organizations for peer review. |
| State Insurance Departments | Provide independent reviews and determinations of adverse healthcare coverage decisions made by health carriers in Kansas and referred by state insurance departments. |
| KDHE, Division of Health Care Finance: Medicaid Utilization Review | Provide utilization review, DRG validation, and quality review services for the State of Kansas, including claims review, high-dollar cost and day outlier claim review, and adjusted claims payment processing on behalf of the State Medicaid program. |
| OHCA: EQRO & QIO | Provide external quality review services to ensure access, quality, and timeliness of care for SoonerCare members. Using the federally mandated CMS EQR protocols, KFMC conducts a review of the managed care organizations and aggregate-level information and validates MCO-collected and submitted performance measures and performance improvement projects. KFMC will also provide utilization review, DRG validation, and quality review services for the State of Oklahoma, including claims review on behalf of the State Medicaid program. |
*KFMC is always accepting new peer review clients.
Interested in learning more about participation in these project opportunities? Don’t see a current opportunity that meets your needs? KFMC offers tailored advisory and consulting services. In addition to defined hourly rates, KFMC can provide custom project or engagement-specific cost proposals.
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