Services

Accident & Forensic Investigation Services

Adverse Determinations Appeal Reviews

Appropriate Coding & Treatment

Benefit Coverage Issues

Chart Reviews

Claims History & Case Reviews

Coding Reviews

Complete Medical Records Reviews

Consumer Grievance Issues

Cosmetic Treatments

Coverage Criteria Evaluations

Disability Claims

DRG Reimbursement Reviews

Emergency Cases

Expedited Appeals

Experimental & Investigational Reviews

External Appeals & Grievance Reviews (Level III)

Functional Capacity/Disability Evaluations

Foreign Language Translation Medical Reviews

Forensic Medical Reviews

Health Benefit Coverage Disputes

Hospital Admissions & Length of Stay

Hospital Accounting/Claims/DRG Reviews

Impairment Ratings

Independent External Medical Reviews

Independent Medical Examinations

In/Out Patient Pre-Certification

Internal Reviews (Initial, Levels I & II)

Level of Care & Impairment

Malpractice Case History Reviews

Medical Necessity Determination Reviews

Medical Necessity External Reviews

Panel Member Appeals or Grievance Hearings

Peer to Peer Reviews

Plan Language Development

Predetermination Reviews

Pre-Surgical Authorizations

Provider Accounting Reviews

Provider Appeals

Provider Claims Reviews

Psychiatry Reviews (Adult, Child & Adolescent, Addiction, Forensic)

Quality of Care Reviews

Thomas Love Medical Necessity External Review Process

Transplantations

Unusual or Disputed Claims Reviews

UCR Audits