As a payor, your organization is committed to providing high quality care to your members that is medically necessary, appropriate and will lead to better outcomes, while controlling overutilization. Federal and state-mandated external appeals are the final stage of the decision-making cycle for a small percentage of health plan members, but critical to upholding the integrity of that commitment.
AllMed provides external appeal services to leading payer organizations of all types, in fulfillment of state and federal regulations. These comprehensive reviews are performed to the highest standards of quality. Determinations are made by our leading panel of board-certified physician peer reviewers, who are licensed and in active practice.
External appeals require extra care in gathering provider and member documentation, ensuring that all evidence is brought to bear on each case determinations. AllMed follows strict protocols for member and provider communication, ensuring these standards are met.
Standard and expedited state and federal external appeals are performed in accordance with all applicable regulations, which are monitored and managed through our in-house compliance program.
AllMed’s external appeal services are delivered through PeerPoint®, AllMed’s state-of-the-art medical review portal, which is easy to use and allows you to monitor the process online.
Most important, our dedicated team is driven by mission to uphold the integrity of the process for all parties concerned. Our commitment to the highest quality and standards of service excellence have distinguished AllMed from other IROs, through the partnerships that we forge with our clients.
Looking for a new external appeals partner? Let’s connect to explore the possibilities.