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Commonwealth of Kentucky CONTRACT DOC ID NUMBER: PON2746Record Date:06/17/22External Quality Review Organization (C3441)Document Description: Cited Authority:Version: 12200003529FAP1114300STD Personal
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Identify the correct external quality review organization based on your organization's needs.
02
Gather necessary documentation and data related to quality measures.
03
Complete any required forms or applications provided by the external quality review organization.
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Submit the completed forms along with the gathered documentation by the specified deadline.
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Prepare for any follow-up communication or requests for additional information from the review organization.

Who needs external quality review organization?

01
Healthcare providers seeking to improve quality of care.
02
Medicaid managed care organizations.
03
Organizations required to meet regulatory compliance and quality standards.
04
Any entity looking to assess their quality performance and outcomes.
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An external quality review organization (EQRO) is an entity that conducts independent assessments of the quality of care delivered by Medicaid-managed care organizations, ensuring that these organizations meet established performance standards and improve service delivery.
Medicaid-managed care organizations are required to file with an external quality review organization, as they must undergo regular independent quality reviews to ensure compliance with Medicaid standards.
To fill out the external quality review organization documentation, organizations must gather necessary performance data, utilize standardized reporting templates provided by the state or federal guidelines, and ensure all information accurately reflects their service delivery and quality metrics.
The purpose of an external quality review organization is to assess, validate, and improve the quality of care provided to Medicaid beneficiaries, ensuring accountability and enhancing healthcare services through systematic evaluation.
Organizations must report comprehensive data on quality indicators, outcomes of care, performance improvement activities, member satisfaction surveys, and adherence to state and federal regulations during the external quality review process.
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