We are uniquely qualified to support the external, independent medical review needs of health plans, third party administrators, and self-insured companies. For over 30 years, we have provided independent, objective medical review and quality assurance services to health care organizations throughout the country. This experience includes serving the federal Medicare program, state Medicaid programs, health plans, benefits administrators, and hospitals.

We are fully accredited under the standards for Independent Review by URAC. Additionally, we are certified as an independent review organization (IRO) to review disputed coverage decisions in 12 states – Arizona, Colorado, Connecticut, Georgia, Indiana, Michigan, New Jersey, Ohio, Oregon, Pennsylvania, Washington, and Wisconsin.

More Than Just Another Opinion

Our independent review team is led by a Medical Director and an RN Service Line Manager experienced in managed care settings, both available 24 hours a day, 7 days a week.

We identify, credential, and maintain a comprehensive physician reviewer panel, covering all major disciplines of medicine, surgery, radiology, therapy, and laboratory medicine.

Determination turn-around times range from 1 day to 20 days, depending on the nature of the case and needs of the client.

We offer several common report formats, but can also customize our reports to your needs. Typical reports contain the following elements: inventory of all materials reviewed, restatement of the review question, analysis and discussion, and conclusions, which are supported by evidence-based, peer-reviewed literature.