Review Services for Medicare and Medicaid Managed Care Organizations

AllMed understands how government programs, including turn-around time and compliance requirements, can impact your business. We help our clients pass their accreditation and compliance audits. Our reviewers have expertise in using various criteria, from policies and guidelines to local and national coverage determinations.

Initial Clinical Review

Scale quickly and efficiently to meet changing demand for initial nurse prior authorization and concurrent reviews. Delegating these reviews to AllMed frees your clinical staff to focus on higher value-added initiatives.

For Medicare and Medicaid

Utilization Management

Flexible, evidence-based reviews, designed to meet your changing needs and ensure compliance with industry, state, and federal requirements while delivering members the highest level of appropriate care.

Nurse Reviews

Nurse and physician prior authorizations, spanning from prospective, concurrent and retrospective review, augment your internal capabilities while containing costs.

Specialty Matched Prior Authorizations

Minimize the need for downstream appeals and costs with customized, specialty-matched authorization reviews. Draw on the expertise of our highly qualified physician peer reviewers for complex, evidence-based determinations.

Independent Appeals

High quality, evidence-based first and second-level reviews by specialists are delivered to the standards you expect and help your organization reduce costs and improve quality.

External Appeals

These comprehensive, high-quality reviews follow federal and state regulations and are monitored and managed through our in-house compliance program.

Reach Out

Interested in using our review services?

Whether you need specialized expertise or added review capacity,
we’re here to help with customized services that fit your exact needs.