External Quality Review Organization (EQRO) and Quality Improvement Organization (QIO) Contractor RFP

The Oklahoma Health Care Authority awarded a contract to provide External Quality Review Organization (EQRO) and Quality Improvement Organization (QIO) services for the SoonerCare Medicaid managed‑care program. The contractor will perform annual external quality reviews, utilization‑review audits, DRG validation, payment‑accuracy measurement, performance‑measure validation, and quality‑improvement support for Managed Care Entities and Dental Benefit Managers. The contract is fixed‑price, includes a mandatory initial term ending June 30 2021, and provides up to six one‑year renewal options. Key obligations include strict HIPAA‑compliant data handling, real‑time MMIS integration, development of dashboards and reports, and participation in OHCA quality‑improvement meetings. • Perform annual EQRO protocols (mandatory and optional) for all MCEs/DBMs. • Conduct utilization‑review, DRG validation, PAM/SA&I audits (≈300 inpatient, 100 outpatient, 100 focus‑area cases per month). • Deliver quarterly and monthly progress reports, annual technical/EPSDT reports, and maintain an operational dashboard. • Maintain a 100 % tobacco‑free office, ensure staff are Oklahoma‑licensed where required, and comply with extensive security standards (HIPAA, SOC 2, FIPS, etc.).