Alliant GMCF has continuously served the Medicaid program since 1972. We offer a comprehensive suite of solutions to help state and federal agencies ensure appropriate spending of Medicaid and Medicare funds and ensure beneficiaries receive health care that is high quality, coordinated, effective, and efficient. We assist our customers through health system evolutions, providing program consultation and analysis for future vision, as well as continuity of program services during transition.

Listed below are Alliant GMCF services. Contact us to discuss how we can help your program.

Utilization Management
  • Prior Authorization
  • Prospective Medical Review
  • Retrospective Medical Review
  • Concurrent Medical Review
  • Level of Care Determination
  • Provider Education
Program Integrity
  • Fraud & Abuse Review/Analysis
  • Payment Error Review/Analysis
  • SURS Review and Focused Studies
  • Member Lock-in Management
  • Utilization and Compliance
  • Provider Education
Quality Management and Improvement
  • Quality Improvement Projects
  • Program Development
  • Program Evaluation
  • Surveys
  • Performance Measurement
  • Quality Assurance
  • Provider Academic Detailing
  • HEDIS (Healthcare Effectiveness Data and Information Set)
Medical Review and Consultancy
  • Medical Policy Consultation
  • Peer Review
  • DRG & Coding Review and Consultation
  • Chart Review/Medical Record Data Abstraction
  • Prepayment Review
  • Claims Review
  • Electronic Health Record
  • Physician Practice Consultation
Provider Services
  • Provider Education/Training
  • Provider Call Center
  • Provider Credentialing
  • Management of Ancillary Certification
    • Nurse Aide Program
    • Medication Aide
Data Management and Analysis
  • Health Data management & Analysis
  • Medical Claims Analysis
  • Provider/Member Profiling
  • Quality/Performance Measure Analysis
  • Data Validation

Value - Our objective is to provide better care at lower cost.

  • Clinically-Led: Our extensive panel of clinicians include approximately 70 specialties across all health care settings.
  • Patient-Centered: Medical reviews and determinations respect the choice and dignity of beneficiaries. We promote patient involvement in health care decisions through training and education.
  • Technology and Data-Driven: Our proprietary MedGuard® system integrates software applications and services to provide health plan integrity functions to identify, recover, and prevent inappropriate payments for health care.
  • Consistent and Reliable Services: Alliant GMCF maintains accreditation in Health Utilization Management by the Health Utilization Management Commission (URAC). This demonstrates our ability to maintain high levels of consistency and reliability in how we perform utilization management services.

To learn more about the GMCF programs and how we can help you, click here.