External Quality Review

CCME provides external quality review to ensure Medicaid recipients receive high-quality, accessible, and timely care. As a multi-state External Quality Review Organization (EQRO) we partner with state agencies and health plans to provide best practice solutions to improve system performance and patient care.

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Quality Improvement

We work closely with clients to identify gaps and risks in health care system delivery and provide the tools, strategy and operational framework necessary to take action, driving tangible results at the citizen, provider, agency and community levels.

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Fraud Waste and Abuse Services

Medicaid programs provide valuable services to a state's citizens - but they are unfortunately targets for financial abuse and exploitation. We evaluate the integrity of payers and providers practices to ensure citizens receive the most value from their programs.

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Utilization Management

We offer expert-level review and clinical analysis of medical records and information to make determinations about the appropriateness and necessity of health care services. Our staff of licensed professionals use our proprietary technology to deliver reliable and defendable decisions to ensure that resources are used judiciously in meeting the needs of patients.

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Admissions Averted

Hospital admissions adverted by increasing vaccinations during a five-year Provider and Practice Transformation program in South Carolina, resulting in more than $97 million in cost avoidance.


Tax Dollars Saved

Taxpayer dollars saved from going to fraud, waste or abuse during a 10-year Investigative Audit program with North Carolina aimed at protecting the integrity of the Medicaid program, citizens lives, providers and communities. For every $1 spent on the program, NC Medicaid saved $7.


Drug Effects Avoided

Adverse drug effects avoided by driving effective patient-centered communication during a five-year Provider and Practice Transformation program with South Carolina.