Managed Care Regulations

State-specific guidelines set to protect healthcare consumers and providers by ensuring that health plans and utilization review agencies meet state-established conditions, standards and regulations; ensuring quality, continuity and access related to healthcare services provided by health plans; monitoring obligations of health plans’ provider contracts and providing health care consumers, providers and purchasers with information about health plans and utilization review agencies; ensuring utilization review agencies are qualified to perform utilization review activities and to make informed decisions on the appropriateness of medical care; and enforcing certified utilization review agencies’ compliance with the required denial and appeals process when utilization review agencies determine that requested healthcare services are not medically necessary or appropriate.

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AllMed Healthcare Management is a URAC-accredited Independent Review Organization (IRO) with an extensive, medical peer review panel comprised of more than 400 board-certified specialists from around the country, providing a high degree of interrater reliability. AllMed provides independent medical reviews and hospital peer review to healthcare organizations, insurance payers, medical managers, claims managers and third party administrators looking to control healthcare costs, while doing the right thing for patients every time.

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Managed Care Regulations

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