Primaris Healthcare Business Solutions

EXTERNAL QUALITY REVIEW ORGANIZATION

Primaris is an External Quality Review Organization (EQRO) of MO HealthNet Division (MHD), Medicaid. More than half a million Missourians are benefitted by Managed Care services provided by the three Managed Care Organizations (MCOs) operating under MHD Managed Care contract. Primaris collaborates with the state agencies and MCOs during Quality Assurance & Improvement (QA & I) meetings on a bi-annual basis.

Primaris analyzes and evaluates quality, timeliness, and access to health care services provided by the MCOs to the Managed Care beneficiaries. The guidelines from Centers for Medicare & Medicaid Services (CMS) External Quality Review (EQR) protocols, version 2, Sept 2012; MHD contract; and MHD’s quality improvement strategy are followed for the purpose of EQR. The following mandatory and Optional activities are conducted, and individual reports are submitted to MHD for each of the activities. Also, a detailed annual technical report is submitted to MHD per 42 CFR 438.364

Mandatory Activities:

  • Compliance with Medicaid Managed Care Regulations
  • Validation of Performance Measures (including Information System Capabilities Assessment)
  • Validation of Performance Improvement Projects

Optional Activities:

  • Care Management Review
  • Secret Shopper Survey

2018 External Quality Review

Annual Technical Report

NOTE: This 301-page online report, prepared by Primaris, is the 2018 external quality review of United Healthcare, Home State Health, and Missouri Care, the managed care organizations contracted through MO HealthNet to provide health care services to managed care enrollees.

Additional reports, all available on the Missouri Department of Social Services website, include:

2017 Technical Assistance


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