External Quality Review Organization (EQRO) Services

The Mississippi Division of Medicaid (DOM) seeks a qualified External Quality Review Organization (EQRO) to conduct mandatory and optional external quality review activities for the state’s Medicaid and CHIP Managed Care Organizations (MCOs). The contractor will validate performance improvement projects, performance measures, network adequacy, encounter data, quality of care surveys, and other federally mandated protocols, and will provide ongoing reporting, analysis, and recommendations to improve care quality, timeliness, and accessibility. The work is performed under a firm‑fixed‑price contract and requires strict independence, data security, and compliance with federal and state regulations. • Perform annual mandatory EQR activities per 42 CFR § 438.350 and related CMS protocols. • Conduct optional EQR tasks such as additional performance‑improvement projects and focus studies. • Review and validate MCO reports (monthly, quarterly, annual) and provide summary findings and recommendations. • Manage data security, privacy, and encryption requirements; all data must remain within the continental United States. • Deliver deliverables through DOM’s secure SharePoint portal; meet strict proposal submission deadlines (questions due Aug 18, SharePoint access by Sep 9, proposal due Sep 18, 2026). • Maintain qualified staff meeting independence standards and possess ≥3 years recent EQRO experience.