Lines Of Business
Workers Compensation
We provide Workers’ Compensation peer reviews to carriers, managed care organizations, Utilization Review Organizations and third party administrators. WC Peer reviews include utilization reviews and file reviews. We understand the importance of state specific requirements, and we offer state match options to meet those state requirements while applying state specific guidelines with a focus on client specific turn around times.
Group Health
Our utilization and quality of care peer review services for group health plans ensures that members of these health plans receive nothing short of the most fitting and essential care, aligning perfectly with medical necessity guidelines and covered plan services. By doing so, we effectively prevent unnecessary medical payments, ensuring cost-effective and efficient healthcare for all.
Auto-Liability
We provide review of questions for No Fault/PIP and Liability claims. Our physician advisors focus on addressing medical necessity, causation-related issues, pre-existing issues, treatment frequency and/or duration and maximum medical improvement.
Disability
We provide peer reviews to disability carriers through an expert physician advisor panel, who are qualified to assess a claimant’s overall functionality, capabilities, restrictions & limitations, with a focus on return to work whenever possible. Both STD and LTD reviews are available, to address functionality vs. workability.
Pharmacy
We provide support in monitoring prescription costs by focusing on the most effective treatment approach via peer to peer discussion. Our expert physician advisors assist in communicating guidelines with recommendations for weaning and discontinuation of inappropriate medications, while focusing on the best treatment approach for the claimant.