For over 25 years, leading payers have been turning to AllMed to process their member and provider specialty-matched appeals for medical, behavioral health, pharmacy benefits, and DME.
Every health plan, MCO, PBM, or TPA has its unique protocols when it comes to managing this process. Some payers use internal physician advisors and Medical Directors for managing first and second-level appeals. However, with more pressure on payers to reduce costs, improve quality, and demonstrate arms-length objectivity to their members and providers, they increasingly turn to companies like AllMed to manage these clinical decision-making processes. This allows you to focus on your core competencies while delegating clinical decision making to Utilization Management and Independent Review Organizations (IROs) like AllMed, who are better equipped to manage the rigorous task of physician specialist credentialing, performance management, quality oversight, and scalability that is needed in today’s hyper-competitive landscape.
AllMed’s specialty-matched appeal review solutions cover the whole gamut, from first and second-level internal reviews to state and federal external appeals. All reviews are conducted by board-certified specialists and sub-specialists who are in active practice. Each appeal review is performed in compliance with URAC, NCQA, CMS, state, and other federal regulations, which are subject to oversight and audit through our Quality and Compliance programs.