Qlarant provided DC’s Medical Assistance Administration with utilization and quality assurance review services for hospitals, specialty hospitals and programs, and nursing facilities; and Medicaid acute and long term care utilization review for the District’s fee-for-service Medicaid program.
Hospital Services included: Acute General Hospitals, Specialty Hospitals including Long Term Acute Care Hospitals, and Inpatient Psychiatric and acute rehabilitation facilities. Services for hospitals include preadmission for elective admissions and emergency admissions, concurrent inpatient reviews, Prior authorization for equipment, Pharmaceuticals, Procedures and Technology, retrospective medical necessity and coding validation reviews.
Long Term Care Services included Preadmission levels of care for nursing home and home and community base waivers, patient assessments for DC residents in Maryland Nursing Homes, 30 day Admission reviews and validation of the reported Admission Minimum Data Set (MDS) by the nursing homes, and continued stay and quality of care reviews for persons residing in nursing homes every quarter.
Specialty Reviews included Residential Treatment Facility Reviews and Comprehensive Rehabilitation Facilities
