HealthInsight New Mexico (formerly NMMRA) is the only federally-designated organization in New Mexico that performs peer review. In addition, HealthInsight New Mexico is the designated External Quality Review Organization for New Mexico.
Medicare Case Review
Under CMS regulations and guidelines, medical cases come to HealthInsight New Mexico for review from various sources:
All medical review done by HealthInsight New Mexico requires evaluation of the medical record of the Medicare beneficiary. HealthInsight New Mexico may review cases for quality of care, appropriateness of discharge, proper utilization and correct DRG assignment. Cases submitted to physician review for determination are conducted by reviewers with qualifications to practice medicine, an active license to practice, and good standing in the community.
HealthInsight New Mexico performs external quality review for state contractors. These reviews include: