Qlarant conducted utilization control of selected hospital, long-term care and community services reimbursed by the Maryland Medicaid Program to ensure that:
- Medical services are authorized only when medically necessary;
- Medical services provided in a hospital on an inpatient basis are authorized only when such services cannot be effectively provided on an outpatient bases or more effectively and efficiently in a facility of a different type;
- Medical services provided in a nursing facility, chronic hospital or in a community-based program are authorized only when an individual is appropriately determined to be medically eligible for services;
- Medical services provided to Medicaid recipients meet professionally recognized standards of quality;
- All authorized medical services are provided in an effective and efficient manner; and
- Abuses of utilization or payment are identified and reported to Maryland Department of Health.
