Iowa Medicaid Enterprise deploys Clear Coverage and InterQual to help make more informed decisions about the use of imaging studies

Iowa Medicaid Enterprise (IME) estimates it is saving $2.4 million a year after deploying Clear Coverage™ and InterQual Criteria to help inform its imaging studies decisions. The administrator for the State Medicaid program, which has about 400,000 members, was facing rising imaging costs as well as potential patient health risks from overutilization of CT scans, PET scans and MRIs. An analysis of radiology utilization found unnecessary procedures could be decreased with preauthorization for high-cost imaging. In March 2010, IME rolled out Clear Coverage to 1,800 network providers. According to IME, the program has met its objectives "to ensure the most appropriate care for members, while reducing the incidence of unnecessary services that waste tax payer dollars and needlessly expose patients to radiation."

To learn more about how IME deployed Clear Coverage and InterQual to help make more informed decisions about the use of imaging studies, click here to view their story, which appeared in Healthcare Informatics.

Back to home