Qsource serves as the independent external quality review organization (EQRO) in Tennessee for TennCare, the Medicaid program, and CoverKids, the Children’s Health Insurance Program (CHIP). We evaluate the quality, timeliness and accessibility of services provided to the adults and children receiving managed care through Medicaid and CHIP health plans, and dual-eligible special needs plans (D-SNPs).
Qsource’s EQRO Division
- assesses contractual and regulatory compliance requirements,
- performs data aggregation and statistical analyses, and
- conducts quality improvement (QI) activities.
We produce meaningful quality assurance, program evaluation, performance measure, population health disparities and health policy reports to inform critical decision-making for our stakeholders. EQRO Division staff members have an in-depth understanding of managed care systems, particularly those that deliver integrated medical, behavioral and long-term care services and supports.
Our Certified HEDIS Compliance Auditors (CHCAs) successfully conduct evaluations within appropriate protocol and regulations, and our biostatisticians and epidemiologists are an asset for any performance improvement project (PIP), and provider or public health patient survey and validation. Using our national quality measure, analytical and reporting expertise, Qsource has also developed population health, utilization and measure-specific reports such as Early and Periodic Screening, Diagnostic and Treatment (EPSDT) focus studies and statewide healthcare report cards with county-level results for diabetes, hypertension and asthma.
These and other services make Qsource an industry leader in quality assurance and medical record review, and a recognized positive force in Tennessee’s evolving healthcare landscape.
Our EQRO Division is based in Nashville, Tennessee. With headquarters in Memphis, Tennessee, Qsource has several office locations and remote staff to ensure localized service; see our contacts to meet your needs.
HEDIS® refers to the Healthcare Effectiveness Data and Information Set and is a registered trademark of the National Committee for Quality Assurance (NCQA). The HEDIS Compliance Audit™ is a trademark of NCQA.