Patient Review and Coordination-About Us

The Patient Review and Coordination program is a federal and state requirement of Medicaid to control the over-utilization and inappropriate use of medical services by clients, allowing restriction of clients to certain providers.

The Patient Review and Coordination program focuses on the health and safety of these clients.  Many of the clients are seen by several different providers, have a high number of duplicative medications, use several different pharmacies, as well as have a high emergency room usage.  Based on clinical and utilization findings, clients are placed in the Patient Review and Coordination program for at least two years.

The Patient Review and Coordination program may assign the client to a specific provider (s) either chosen by the client or assigned by the program.  Clients can be assigned to one primary care provider, one pharmacy, one hospital for non-emergency care, one narcotic prescriber or any combination of these providers.  The assigned provider will coordinate client's medical needs, monitor and educate clients about the appropriate use of services. 

Clients who have been on the Patient Review and Coordination program have shown a decrease of inappropriate use of medical services.

For comments or questions regarding Patient Review and Coordination, email contact us