Medicaid agency presents three renewals for utilization review, EQRO and pharmacy administration

James Hart, representing the Alabama Medicaid Agency, presented three renewal contracts. He said federal law requires the state to monitor utilization of Medicaid services and that Comagine Health provides retrospective inpatient hospital reviews for appropriateness, length of stay, and billing for Medicaid-enrolled hospitals. Island Pure Review Organization (doing business as iPRO) is an external quality review organization (EQRO) that audits seven ACHN contractors to validate compliance with service documentation and case-management timelines. Keystone (doing business as Centra Health) was described as the pharmacy program administrator that processes prior-authorizations and supports the Drug Utilization Review Committee.

Committee members had no extended questions in the recorded transcript; Hart summarized the contracts as renewals of previously approved agreements and explained the operational roles each contractor plays in meeting federal oversight and program-administration requirements.