Independent Medical Review
As a claims payor, the pressure is on you to manage healthcare utilization and control claims costs, while making sure each of your members gets the benefits he/she deserves. Yet the increasing complexity of medical treatments and constantly shifting standards of care make it difficult for most payor organizations to maintain the specialist knowledge they need in-house. Regulatory bodies require evidence-based decision making by an objective party with same specialty training and credentials. Add to this the sheer volume of claims being processed by most claims organizations, and it’s a wonder that you can get your job done. Sound familiar?
When you need fast, cost effective medical peer reviews, you need AllMed Healthcare Management. We’re the IRO (independent review organization) of choice for leading health insurance carriers, medical management firms, third party administrators and stop loss carriers. We provide specialty-matched medical necessity reviews that improve your claims decision making, whether it be for first-level or second-level determinations, or for appeals. What’s more, we customize our services to each client’s needs, in order to tightly integrate with your workflow.
AllMed will:
- Provide independent medical reviews and evaluations that quickly resolve complex problems - saving you money while protecting the integrity of patient care;
- Use board-certified specialists who actively practice in the specific treatment area related to each review;
- Review chart notes and operative reports to render evidence-based determinations which are objective and free from conflict of interest;
- Supply professional and easy-to-read medical reviews along with supporting rationale and references;
- Consult with a member’s attending physicians as necessary and appropriate;
- Apply your plan language to each case, if appropriate, including definitions, exclusions, covered benefits, etc.
Working with AllMed is easy, and our clients especially appreciate getting direct access to our in-house physicians for free consultation, via our MedConsultTM telephone hotline
Want more information about our medical peer review services? Click Here to watch our movie, or download our materials below.
"AllMed is professional, they're prompt, and they're always accessible on the phone. You call them and boom, you get an answer back. When I have a question, they always return my call in just a short amount of time. I highly recommend them."
