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Surveillance and Utilization Review Services

Review of recordsTMF Health Quality Institute plays a key role in state health care as well as in national efforts. Since 2008, TMF has served the Texas Health and Human Services Commission by performing Medicaid surveillance and utilization reviews. TMF performs medical record review of Texas Medicaid providers to determine medical necessity and compliance with Medicaid policies. TMF works closely with the Office of Inspector General (HHSC-OIG) to perform retrospective medical record review for both fee-for-service and Medicaid managed care to assess medical necessity and quality, and to identify compliance with Medicaid medical/dental and program policies and correct coding.