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Medical Review Solutions For Improved Quality and Reduced Costs

 

An extension of your team

Health plans, TPAs, MCOs and medical management organizations are confronting more and more challenges as the healthcare market becomes increasingly complex and competitive. Not only do you face a daily flood of pre-authorizations, claims and appeals, you also must make objective medical necessity determinations under tight deadlines.

Increasingly complex medical procedures, devices and drug therapies along with constantly shifting standards of care are further complicating UM and appeals processes. Building and maintaining internal specialty resources for timely clinical decision-making is a challege for most payer organizations.

This is where AllMed can help. We serve as an extension of your team, with physician peer reviewers, medical directors, clinicians, clinical copy editors and customer resources that enable you to achieve high quality, while reducing costs.

With AllMed's medical review solutions, your organization gains access to our comprehensive solution that support medical management decision making across the spectrum of utilization review, case management, appeals, and state and federal appeals. Our high quality review solutions ensure that your members receive superior care that meets medical necessity and coverage criteria, while controlling over-utilization. And we deliver with industry-leading turn-around times that meet your needs.

Making clinical determinations is a critical function in healthcare payer organizations. With AllMed's easy partnering solutions, your health plan or medical management organization can reduce costs, while ensuring high quality and compliance.

AllMed's Medical Review Solutions offer:

  • Repeatable, consistent quality and turnaround time
  • Customization to meet your exact needs
  • Compliance with URAC,  NCQA, CMS & other applicable standards

All review are processed through , AllMed's Medical Review Portal, providing faster case processing, automation to reduce errors, and immediate access to cases, with no waiting. With  PeerPoint®, your information is protected by the highest security standards in the industry - HITRUST.

Want to learn more about how AllMed's medical review solutions can help your organization save time and money? Download this free white paper.