The RAC for Region C, Connolly Healthcare, has evidently decided to use Milliman guidelines as their preferred tool for judging status designations in Medicare facility-based claims.
We received an email from a client facility, quoting an email from Christine Castelli, Principal, Healthcare Division, Connolly Consulting, dated May 25, stating the following:
“..As of today, Connolly will be using Milliman. Please be aware that both Milliman or InterQual are only tools, they are not decision makers.”
Region C States:
CO, NM, OK, TX, AR, LA, MS, AL, TN, GA, FL, SC, NC, VA, WV
Connolly Healthcare Services website:
http://www.connollyhealthcare.com/RAC/Pages/cms_RAC_Program.aspx
Milliman Guidelines website: http://www.careguidelines.com/
Analysis Coming Soon:
We will be posting soon an analysis of what impact we can determine that this might have on audits of claims from facilities that use the competing and more popular guidelines, McKesson’s InterQual guidelines.
Your comments and questions are welcome here on our journal, so please feel free to register and post! Stay tuned for more details…
Tags: InterQual, Milliman, rac, recovery audit contractor, status designation