HealthCare Quality Improvement Organizations (QIO) and QIO Directory

HealthCare Quality Improvement Organizations (QIO) and QIO Directory

What are QIOs?

CMS contracts with one organization in each state, as well as the District of Columbia, Puerto Rico, and the U.S. Virgin Islands to serve as that state/jurisdiction’s Quality Improvement Organization (QIO) contractor. QIOs are private, mostly not-for-profit organizations, which are staffed by professionals, mostly doctors and other health care professionals, who are trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care. QIO contracts are 3 years in length, with each 3-year cycle referenced as an ordinal “SOW.”

What do QIOs do?

By law, the mission of the QIO Program is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. Based on this statutory charge, and CMS’ Program experience, CMS identifies the core functions of the QIO Program as:

  •  Improving quality of care for beneficiaries;
  • Protecting the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for services and goods that are reasonable and necessary and that are provided in the most appropriate setting; and
  • Protecting beneficiaries by expeditiously addressing individual complaints, such as beneficiary complaints; provider-based notice appeals; violations of the Emergency Medical Treatment and Labor Act (EMTALA); and other related responsibilities as articulated in QIO-related law.


QIO Directory

Alabama AQAF
Alaska Mountain-Pacific Quality Health
Arizona Health Services Advisory Group, Inc.
Arkansas Arkansas Foundation for Medical Care
California Health Services Advisory Group of California, Inc.
Colorado Colorado Foundation for Medical Care
Connecticut Qualidigm
Delaware Quality Insights of Delaware
District of Columbia Delmarva Foundation of the District of Columbia
Florida FMQAI
Georgia Georgia Medical Care Foundation (GMCF)
Hawaii Mountain-Pacific Quality Health
Idaho Qualis Health
Illinois Telligen Illinois
Indiana Health Care Excel
Iowa Telligen
Kansas Kansas Foundation for Medical Care, Inc.
Kentucky Health Care Excel
Louisiana eQHealth Solutions
Maine Northeast Health Care Quality Foundation
Maryland Delmarva Foundation for Medical Care
Massachusetts Masspro
Michigan MPRO
Minnesota Stratis Health
Mississippi Information & Quality Healthcare
Missouri Primaris
Montana Mountain-Pacific Quality Health
Nebraska CIMRO of Nebraska
Nevada HealthInsight
New Hampshire Northeast Health Care Quality Foundation
New Jersey Healthcare Quality Strategies, Inc.
New Mexico New Mexico Medical Review Association
New York IPRO
North Carolina The Carolinas Center for Medical Excellence
North Dakota North Dakota Health Care Review, Inc.
Ohio Ohio KePRO
Oklahoma Oklahoma Foundation for Medical Quality
Oregon Acumentra Health
Pennsylvania Quality Insights of Pennsylvania
Puerto Rico Quality Improvement Professional Research Organization, Inc.
Rhode Island Quality Partners of Rhode Island
South Carolina The Carolinas Center for Medical Excellence
South Dakota South Dakota Foundation for Medical Care
Tennessee QSource
Texas TMF Health Quality Institute
Utah HealthInsight
Vermont Northeast Health Care Quality Foundation
Virgin Islands Virgin Islands Medical Institute, Inc.
Virginia VHQC
Washington Qualis Health
West Virginia WVMI Quality Insights
Wisconsin MetaStar, Inc.
Wyoming Mountain-Pacific Quality Health


Source: CMS


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