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MetaStar conducts Information Systems Capability Assessments (ISCAs), a required part of other mandatory External Quality Review protocols. ISCAs help ensure that each Managed Care Organization (MCO) maintains a health information system that can accurately and completely collect, analyze, integrate, and report data on member and provider characteristics, and on services furnished to members.
To conduct ISCAs, MetaStar develops the methodology and tools in collaboration with the Wisconsin Department of Health Services (DHS), using information on system requirements detailed in the DHS-MCO contract; other technical references, such as the CMS guide, EQR Protocol Appendix V: Information Systems Capability Assessment – Activity Required for Multiple Protocols; and the Code of Federal Regulations at 42 CFR 438.242 .
For each MCO/Health Maintenance Organization (HMO), the review process consists of a review of requested and submitted documents; interviews with staff; an analysis and compilation of findings; and a report to DHS and the MCO/HMO.