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Quality of Care

Specializing in independent medical reviews and quality-of-care services

Contact Us

For information about our quality of care services, e-mail us.

Did You Know?

As the NQMC, MAXIMUS provides independent evaluation of the quality of care received by Military Health System beneficiaries and their dependents. Since assuming contract responsibility more than six years ago, we have reviewed over 60,000 cases with a performance accuracy rating in excess of 99%.

Medical Reviews and Quality of Care

MAXIMUS employs a specialized team of health professionals to deliver independent medical reviews and quality of care services, such as:

  • Medical chart audits using nationally sanctioned, or custom developed, quality and patient safety criteria
  • Compliance assessment services
  • Medical necessity determinations
  • Clinical evidence-based protected peer reviews
  • Malpractice and substandard care allegation assessments
  • Medical technology assessments
  • On-site provider surveys and certifications
  • Quality improvement plan audits and related project assessments
  • Health plan compliance assessments and health analytics

Our specialized team is drawn from a wide spectrum of health practitioners including physicians, pharmacists, therapists, nurses, health attorneys, and a national panel of consulting practitioners. Collectively these individuals represent all medical specialties as designated by the American Board of Medical Specialties and all licensed allied health professions. 

Quality of Care Services for Major Health Programs

MAXIMUS provides independent medical review services for large government-sponsored health programs. Our industry leading experience includes:

  • Serving as the designated National Quality Monitoring Contractor for the Department of Defense (DoD) TRICARE Management Activity (TMA) 
  • Delivering independent medical review services to the Department of Veterans Affairs (VA) Veterans Integrated Service Network 23, facilitating improvements in health care delivery, assessing patient safety and monitoring overall clinical performance within VA medical centers across Nebraska and western Iowa
  • Assessing the merits of patient allegations of substandard care through protected peer reviews for the Massachusetts Medical Board

Quality Commitment

MAXIMUS is fully accredited by the Utilization Review Accreditation Commission (URAC) as an independent review organization. URAC is the only nationally recognized accreditation program for independent review organizations. MAXIMUS has maintained full accreditation since it was first accredited by URAC in 2000. Most of the company’s independent review programs are also ISO 9001:2000 certified.