Prairie States Receives NCQA Accreditation in Utilization Management

Prairie States Receives NCQA Accreditation in Utilization Management

Prairie States, the Sheboygan-based third party administrator of self-funded employee health benefit plans, has been accredited by the National Committee for Quality Assurance (NCQA) in Utilization Management. NCQA Utilization Management Accreditation is a quality assessment program that focuses on consumer protection and customer service improvement.

Achieving NCQA Utilization Management Accreditation demonstrates that Prairie States has the systems, processes and personnel in place to conduct utilization management in accordance with the strictest quality standards.

Utilization management helps ensure that patients have the proper care and the required services without overusing resources. NCQA Utilization Management Accreditation helps guarantee that organizations making these decisions are following objective, evidence-based best practices.

Prairie States was founded by a nurse practitioner, so the clinical approach has been a hallmark of our Utilization Management program from the very beginning, said Jessica West, MSN, RN, Vice-President of Clinical & Health Services at Prairie States. Our experienced in-house team of nurses, supported by a full panel of physician specialists, review all inpatient and outpatient services to identify questionable medications and procedures, while also making certain that doctor orders are carried out in an efficient and accurate manner. In the end, this means greater transparency, lower healthcare costs, and improved patient care.

As the cost of care continues to rise nationwide, a proven and effective Utilization Management program is essential for every health plan in today’s complex and evolving healthcare marketplace, Prairie States Founder CEO Felicia Wilhelm said in a statement. This prestigious accreditation from NCQA reinforces our steadfast commitment at Prairie States to ensuring that all members receive the right care, at the right time, and at the best value for their plan.

Note: NCQA has reviewed and accredited Prairie States’ Utilization Management functions only. For complete details on the scope of this review, visit

About NCQA

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s website ( contains information to help consumers, employers and others make more- informed health care choices. NCQA can be found online at, on Twitter @ncqa, on Facebook at and on LinkedIn at

About Prairie States

Prairie States delivers the programs, insights and expertise to bend the trend of rising healthcare costs. Paired with a staff of incredibly dedicated, informed and responsive people who care about the members they serve, this integrated approach allows us to identify ways to save on costs for employers, without compromising the quality of care for employees and their families. Prairie States provides cutting-edge health benefits administration with a human touch. It’s a difference you’ll notice the very first moment we start working together and one you’ll wonder how you ever did without.

Prairie States Enterprises, Inc. is a third-party health benefits plan administrator that brings industry expertise and a clinical focus to self-insured companies. Our in-house claims administration, health management services, wellness programs, plan analysis and predictive modeling tools result in remarkable and unprecedented cost control for employers. We also provide the most compassionate and personalized level of service for plan members.
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