Advocare certified to provide utilization review for state Medicaid agencies

MERRILLVILLE, Ind. - Indiana-based health technology services firm Advocare has received federal certification as a designated Quality Improvement Organization (QIO)-like entity.

This means Advocare can now provide utilization reviews and health quality management services to state Medicaid agencies across the country. The Centers for Medicare & Medicaid Services (CMS) administers the QIO-like entity designation.

Under federal law, state Medicaid agencies can contract with a QIO or QIO-like entity to perform medical and utilization review functions required by law. As part of the QIO-like designation, Advocare can pursue state Medicaid contracts for utilization review, and work with consumers, physicians, hospitals and other caregivers to ensure that patients receive the right care at the right time.

The QIO-like entity designation, which must be revalidated every three years, originates in Advocare's home state of Indiana, but extends to all other states and Puerto Rico. Advocare is currently providing health care management technology support for the State of Indiana's Medicaid Waiver program.

A wholly owned subsidiary of Merrillville-based health care data management firm interLink, Advocare's QIO-like entity designation reflects the company's goals of improving quality of care and lowering costs through integrated technology, with emphasis on underserved populations such as Medicare and Medicaid beneficiaries. According to Richard Metzger, Advocare managing director, the QIO-like entity certification enriches that relationship.

"Advocare's QIO-like status ensures the state of Indiana, and all of our future customers, receive the full breadth of Advocare's experience and knowledge at an even deeper level," he said. "This CMS designation complements Advocare's understanding of the human services field, and our expertise in integrating accessible technology that can minimize cost, ensure quality and provide measurable data across a broad number of traditional environments."

Among the criteria Advocare met to achieve this certification included obtaining the status as a physician-access organization, demonstrating the ability to perform medical and quality-review functions, and establishing the presence of a consumer advocate on its governing board.

Advocare's corporate office is located in the Purdue Research Park of Northwest Indiana in Merrillville.

About interLink

interLink provides IT, communications, and senior-level management to organizations to achieve "Maximum growth. Minimum time." Working in close collaboration with their partners, interLink listens and responds with informed, strategic, and process-driven solutions to ensure partner initiatives are implemented and objectives are satisfied in an efficient, measureable, and transparent manner.

About Purdue Research Park

The Purdue Research Park, with four locations across Indiana, has the largest university-affiliated business incubation complex in the country. The park network is home to about 240 companies that employ about 4,500 people and are located in West Lafayette, Indianapolis, Merrillville and New Albany. 

Purdue Research Park contact: Steve Martin, 765-588-3342, sgmartin@prf.org