We conduct utilization management and compliance reviews and provide data-driven solutions that help control expenditures while ensuring that patients receive appropriate and timely care.
CCME conducts expert review of combined claims and clinical data, offering customers information that can help inform business decisions. Our current work involves prior authorization, external quality review, focused care studies, quality assurance and quality improvement activities, and compliance audits.
We provide the following services:
CCME has also provided retrospective utilization reviews for Medicare beneficiaries as a Quality Improvement Organization contracting with CMS in North Carolina (1984 to 2014) and South Carolina (1988 to 2014).