Connolly Healthcare, a permanent Recovery Audit Contractor (RAC) for the Centers for Medicare & Medicaid Services (CMS), has signed a five-year license agreement with Milliman Care Guidelines.

Connolly will use the Care Guidelines content and software to review Medicare claims in 15 states — West Virginia, Virginia, North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Louisiana, Tennessee, Arkansas, Texas, Oklahoma, New Mexico, Colorado — plus the territories of Puerto Rico and the US Virgin Islands. Under federal law, RACs review claims for compliance with CMS reimbursement policies, and identify both underpayments and overpayments. According to CMS, the RAC Program will rollout nationwide by January 1, 2010.

Connolly will use all of the annually updated, evidence-based Care Guidelines products — Ambulatory Care, Inpatient and Surgical Care, General Recovery Guidelines, Recovery Facility Care, Home Care, Chronic Care Guidelines, and Behavioral Health Guidelines. CMS does not mandate or endorse the use of any specific screening product for medical reviews.

“The breadth and detail of the Care Guidelines enable informed and consistent clinical decisions for the best possible care throughout the entire care continuum,” said Scott Harris, Milliman Care Guidelines Senior Vice President of Sales and Marketing. “Having access to our evidence-based clinical tools enables quality and audit organizations to effectively manage their review processes and initiatives to improve the care provided for Medicare beneficiaries.”

The Care Guidelines promote healthcare quality by providing clinical guidelines based on the best available clinical evidence. The Care Guidelines also incorporate detailed quality measures from the Hospital Quality Alliance (CMS Core Measures) and other national standards-setting groups. Each guideline topic outlines key issues, and provides details on clinical interventions to improve patient outcomes.

Connolly Healthcare is a division of leading global recovery audit firm Connolly. Connolly assists clients in the industries of healthcare, retail, commercial, and government in recovering hundreds of millions of dollars annually in erroneous payments to suppliers, vendors, and providers. These errors are endemic to any large organization and result in significant lost dollars every year if not recovered. Recovery auditing is recognized as a best practice and Connolly’s expertise places it in a position to propose vital process improvement recommendations to reduce or eliminate future payment errors.

Information on Connolly Healthcare and its services can be obtained at: www.connollyhealthcare.com.

Milliman Care Guidelines LLC, A Milliman Company, is located in Seattle, and independently develops and produces evidence-based clinical guidelines and a variety of software options that are used by more than 1,000 US and international clients, and support the care of almost two-thirds of US health plan members. Covering the continuum of care, the seven-product Care Guidelines series is updated annually by an experienced team of clinicians. For more information, visit www.careguidelines.com.

Milliman Care Guidelines is a wholly owned subsidiary of Milliman, Inc., which is among the world’s largest independent actuarial and consulting firms. Founded in Seattle in 1947 as Milliman & Robertson, the company now has 49 offices in key locations worldwide. Milliman employs more than 2,000 people, with a professional staff of more than 1,000 qualified consultants and actuaries, including specialists ranging from clinicians to economists. The firm has consulting practices in healthcare, employee benefits, property and casualty insurance, life insurance, and financial services. Milliman serves the full spectrum of business, financial, government, union, education and nonprofit organizations. For more information, visit www.milliman.com.