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Pharmacy

Pharmacy

 

pre-authorizations & appeals of drug benefits

AllMed has expanded MedCert to include Medicare Part D reviews in response to the growing needs of its clients and partners in health care. Payers facing an increased workload due to the Part D ruling can easily run to independent review to outsource the physician review. AllMed is committed to meeting the needs of its clients and ensuring the highest quality determinations to improve health care and quickly adapting to the constantly evolving regulatory environment.

MedCert is an outsourcing solution designed to:

  • Provide physician review cases from utilization review and case management
  • Free up in-house Medical Director resources to focus on strategic, value-added activities
  • Handle changing medical review caseloads and volume fluctuations

With MedCert, expenses associated with medical review activities becomes variable based on caseload, instead of remaining fixed. Quick turnaround times and defensible determinations are other advantages of MedCert.

AllMed's board-certified physician reviewers handle all MedCert reviews. Each MedCert review provides "certify" or "non-certify" determinations and an abbreviated rationale in electronic format. MedCert is deployed through PeerPoint, AllMed's proprietary medical review portal, which allows seamless integration of MedCert with an organization's clinical operations workflow and meets the highest information security standards.