EQRO

Qsource serves as an independent external quality review organization (EQRO) for Medicaid programs and Children’s Health Insurance Programs (CHIPs). 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,
  • formulates study and sampling methods,
  • develops audit and data collection tools,
  • performs data aggregation and statistical analyses, and
  • conducts quality improvement (QI) activities.

Using our national quality measure, EQR protocol, regulatory, analytical and reporting expertise, Qsource facilitates performance improvement project (PIP) and provider or public health patient survey and data validation, and develops utilization and measure-specific reports with national, state and county results, such as focus studies on EPSDT and other child health topics, as well as provider and beneficiary satisfaction.

We produce meaningful program evaluation, performance measure, population health, disparities and health policy reports to inform stakeholders’ critical decision-making. Our qualified EQRO staff has an in-depth understanding of managed care systems, particularly those that deliver integrated medical and behavioral health, and long-term care services and supports (LTSS and MLTSS):

  • Certified HEDIS Compliance Auditor (CHCA)
  • Clinical QI Specialists
  • Healthcare Data Analysts
  • Biostatisticians and Epidemiologists
  • Call-Center Staff and Technical Writers

Qsource works with state health agencies and managed care health plans, offering training and assistance to help meet state strategic quality objectives. These and other services make Qsource an industry leader in quality assurance and medical record review, and a recognized positive force in states’ evolving healthcare landscape.

With corporate headquarters in Memphis, Tennessee, and an EQRO Division based in Nashville, Qsource has several office locations and remote staff in the United States 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. 

EQRO Division
49 Music Square West, Suite 402
Nashville, TN 37203
Phone: 866-514-8595 Local: 615-244-2007
Fax: 615-244-2018

John Couzins, MPH, CHCA
EQRO Director

Lois Heffernan
EQRO Program Manager—Florida

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Stacy Spreainde, MPA, LSW
EQRO Project Director—Ohio

Swapna Mehendale, MHA, BPharm
EQRO Program Manager—Tennessee

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TennCare Health Plan Meeting Highlights

.pdf iconFebruary 2019 Meeting
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June 2019 Meeting
.pdf iconSeptember 2018 Meeting