External Quality Review Organization
The State seeks to secure a contract with a highly qualified and experienced External Quality Review
Organization (EQRO) to assist in reaching its goal of ensuring that each enrollee can access timely, high
quality, medically necessary, covered healthcare services. The Balanced Budget Act (BBA) of 1997
requires that the State Medicaid agencies contract with qualified outside entities to conduct an annual
review of managed care plans, who will at a minimum be required to annually review the quality
outcomes, timeliness of, and access to services for which the managed care plan and Dental Benefits
Manager (DBM) is responsible under its contract. Currently in Tennessee there are seven (7) managed
care plans, including the statewide plan for those enrollees determined to be at high risk, and one (1)
(DBM).
Non-mandatory pre-proposal conference 06/29/2010.
