EXTERNAL REVIEWS
QUALIFICATIONS AND ACCREDITATIONS
- URAC Accreditation as an Independent Review Organization (IRO)
- ISO 9001:2015 Registration
- Certified Women-Owned Small Business
- HIPAA Compliance Program
- CMMI-DEV Level 3 Accreditation
EXPERTISE
Medical and legal experts who make a difference:
- Physicians: Board certified and licensed physicians in all specialties. Subspecialties
in both surgery and medicine, including (but not limited to):
- > Addiction Medicine
- > Breast Imaging
- > Cardiothoracic Surgery
- > Chiropractic
- > Genetics
- > Infertility
- > Neonatology
- > Oncology
- > Pain Management
- > Physical Medicine & Rehab
- > Psychiatry
- > Urology
- Pharmacists: Board Certified/Licensed
- Nurses: Licensed/Certified in Coding
- Allied Health Professionals: Licensed
- Coding Specialists: Certified in Hospital & Provider Coding
- Attorneys for Coverage Eligibility Reviews
INTEGRITY AND EXPERIENCE
- Case review for Medicare Parts A, B, C, and D claims affecting over 40M beneficiaries
- Oversight of Medicare’s national payment recovery program, identifying $370M in overpayments for return to providers in the first 4 years
- United States Postal Service Office of Inspector General medical review of over 600 potential fraud leads since 2011
- Workers’ Compensation case review with nearly $2.6 billion in Medicare set-aside dollars since 2011
- External medical review for state health plans with over 170,000 beneficiaries
- Clinical peer review for the Department of Veterans Affairs for 10 years
- Department of Justice medical review with a single case resulting in a $77M fraud scheme conviction
EDUCATION AND SUPPORT
- Legal team to help you interpret external medical review regulations
- Easy electronic submission
- Fast turnaround to meet federal/state regulations and your specific needs
