Skip to main content
Off canvas

HealthInsight New Mexico’s External Quality Review Organization Receives New Contract

HeathInsight New Mexico’s External Quality Review Organization (EQRO) has been awarded a new two-year contract from the New Mexico Human Services Department, Medical Assistance Division (HSD) to perform the Centennial Care Managed Care Organization (MCO) EQRO audits for the state of New Mexico.

HealthInsight New Mexico has served as the Medicaid EQRO under contract with HSD continually since 2005, providing quality oversight for all Medicaid managed care physical health, behavioral health and long-term care contracts.

HealthInsight New Mexico’s EQRO remains dedicated to providing independent external reviews of the quality, timeliness and accessibility of the care and services provided to Medicaid beneficiaries by Medicaid MCOs. As required by the Centers for Medicare & Medicaid Services (CMS), this activity helps to ensure MCO adherence to the managed care contracts with HSD, the New Mexico Administrative Code (NMAC) regulations and federal regulations.

“We are pleased to be awarded this contract from HSD, which supports HSD’s commitment to providing quality health care to New Mexico’s Medicaid Managed Care members. Medicaid members benefit from our reviews because the reviews are designed to improve the quality and access to health care services,” said Margy Wienbar, executive director of HealthInsight New Mexico.

The major strategic aims of the upcoming two-year workplan for HSD include the following:
  • Further improve the Medicaid Managed Care Delivery system by completing the quality reviews mandated by CMS for compliance, performance measurement and performance improvement projects
  • Review nursing facility level of care determinations to assure HSD and the public that the most vulnerable Medicaid members are receiving all the care to which they are entitled under Medicaid
  • Conduct a performance measures data analytics project that monitors Centennial Care program performance measures
With the award of this contract, HealthInsight New Mexico will continue to serve as a primary agent in focusing community energy to improve the quality and effectiveness of health care.