Navigation Links
Recovery Audit Contractor HealthDataInsights Licenses Milliman Care Guidelines(R)

Evidence-Based Care Guidelines will be used to Combat Waste in Medicare Programs

SEATTLE, March 3 /PRNewswire/ -- HealthDataInsights, Inc. (HDI), a permanent Recovery Audit Contractor (RAC) for the Centers for Medicare & Medicaid Services (CMS), has signed a five-year license agreement with Milliman Care Guidelines(R). HDI will use the Care Guidelines content and software to review Medicare claims.

HDI is the RAC for 17 Western states -- Montana, Wyoming, North Dakota, South Dakota, Utah, Arizona, Alaska, California, Hawaii, Idaho, Iowa, Kansas, Missouri, Nebraska, Nevada, Oregon and Washington. CMS has announced that the RAC Program rollout will be nationwide by January 1, 2010. Under federal law, RACs review claims for compliance with CMS reimbursement policies, and identify both underpayments and overpayments.

HDI will use the annually updated, evidence-based Care Guidelines products -- Ambulatory Care, Inpatient and Surgical Care, General Recovery Guidelines, Recovery Facility Care, Home Care, Chronic Care Guidelines and Behavioral Health Guidelines. CMS does not mandate or endorse any specific guidelines or criteria for utilization reviews.

"This breadth and detail of the Care Guidelines enable informed and consistent clinical decisions for the best possible care management throughout the entire care continuum," said Scott Harris, Milliman Care Guidelines Senior Vice President of Sales and Marketing. "Having access to our evidence-based clinical tools also enables quality and audit organizations to effectively manage their review processes and initiatives to improve medical care delivery."

The Care Guidelines promote healthcare quality by providing clinical guidelines based on the best available clinical evidence. The Care Guidelines also incorporate detailed quality measures from the Hospital Quality Alliance (CMS Core Measures) and other national standards-setting groups. Each guideline topic outlines key issues, and provides details on clinical interventions to improve patient outcomes.

About HealthDataInsights

HealthDataInsights, headquartered in Las Vegas, uses proprietary software and conducts medical reviews to analyze clients' healthcare claims to identify and recoup improper payments. The company's experienced management team has previously worked together to build major healthcare companies, including dialysis and infusion therapy services. The company has operations in Fountain Valley, Calif., and Orlando, Fla. For more information, visit

About Milliman Care Guidelines

Milliman Care Guidelines LLC, A Milliman Company, is located in Seattle, and independently develops and produces evidence-based clinical guidelines and a variety of software options that are used by more than 1,000 clients nationally and support the care of almost two-thirds of US health plan members. Covering the continuum of care, the seven-product Care Guidelines series is updated annually by an experienced team of clinicians. For more information, visit

About Milliman

Milliman Care Guidelines is a wholly owned subsidiary of Milliman, Inc., which is among the world's largest independent actuarial and consulting firms. Founded in Seattle in 1947 as Milliman & Robertson, the company now has 49 offices in key locations worldwide. Milliman employs more than 2,000 people, with a professional staff of more than 1,000 qualified consultants and actuaries, including specialists ranging from clinicians to economists. The firm has consulting practices in healthcare, employee benefits, property and casualty insurance, life insurance, and financial services. Milliman serves the full spectrum of business, financial, government, union, education and nonprofit organizations. For more information, visit

SOURCE Milliman Care Guidelines
Copyright©2009 PR Newswire.
All rights reserved

Related medicine news :

1. CRC Health Group Announces Acquisition of Bayside Marin Recovery Center, San Rafael
2. 4-Star Gen. Barry Mccaffrey, Former U.S. Drug Czar, to Keynote Recovery Happens! Rally for Treatment: Wed., Sept. 5, 11 Am, State Capitol West Steps, Sacramento
3. Treating depression may improve recovery of heart rate variability following coronary syndromes
4. Recovery Resources Collaborates with Two Nonprofit Agencies for Children of Alcoholics Outreach Program
5. Joint NJ/NY Rally for Addiction Recovery to Be Hub of Events Nationwide
6. CRN Announces Syndication Launch for Recovery Talk Network
7. Altarum Wins $7 Million Contract to Provide Technical Assistance to the Access to Recovery Program
8. The First Mega-Shelter Arrangement in Oregon Created for Major Disaster Response and Recovery
9. Eli Lilly and Company Aids California Recovery Effort
10. Substance abuse practitioners ask what is recovery?
11. Low Levels of Good Cholesterol May Slow Stroke Recovery
Post Your Comments:
(Date:6/26/2016)... Cary, North Carolina (PRWEB) , ... June 26, 2016 , ... ... the release of a new product that was developed to enhance the health of ... harvested for centuries. , The two main herbs in the PawPaws Cat Kidney ...
(Date:6/25/2016)... ... ... temporary closing of Bruton Memorial Library on June 21 due to a possible lice infestation, ... aspect of head lice: the parasite’s ability to live away from a human host, and ... necessary one in the event that lice have simply gotten out of control. , As ...
(Date:6/25/2016)... ... ... Friday, June 10, Van Mitchell, Secretary of the Maryland Department of Health and Mental ... exemplary accomplishments in worksite health promotion. , The Wellness at Work Awards took place ... BWI Marriott in Linthicum Heights. iHire was one of 42 businesses to receive an ...
(Date:6/24/2016)... ... ... crisis. Her son James, eight, was out of control. Prone to extreme mood shifts and ... him, he couldn’t control his emotions,” remembers Marcy. “If there was a knife on ... say he was going to kill them. If we were driving on the freeway, ...
(Date:6/24/2016)... ... ... BioMedics, Inc, makers of Topricin and MyPainAway Pain Relief Products, join The ‘Business for a ... an hour by 2020 and then adjusting it yearly to increase at the same rate ... assure the wage floor does not erode again, and make future increases more predictable. , ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... , June 24, 2016   Pulmatrix, Inc ... company developing innovative inhaled drugs, announced today that it ... Russell Investments reconstituted its comprehensive set of U.S. ... "This is an important milestone for Pulmatrix," said ... increase shareholder awareness of our progress in developing drugs ...
(Date:6/23/2016)... , June 23, 2016 Any dentist who ... challenges of the current process. Many of them do not ... the technical difficulties and high laboratory costs involved. And those ... offer it at such a high cost that the majority ... Dr. Parsa Zadeh , founder of Dental ...
(Date:6/23/2016)... 2016 Capricor Therapeutics, Inc. ... biotechnology company focused on the discovery, development and ... enrollment in its ongoing randomized HOPE-Duchenne clinical trial ... of its 24-patient target. Capricor expects the trial ... of 2016, and to report top line data ...
Breaking Medicine Technology: