About Us

NMR is an Independent Internal and External Medical Review Organization with URAC Accreditation. Since 1996 NMR has been serving:

• Insurance Companies

• State Insurance Departments

• Third Party Administrators

• Federally Regulated Agencies

• ERISA Regulated Benefit Plans

• Utilization Management Companies

• Hospitals

• Law Firms

• Medical Review Companies. 

 Issues Addressed

NMR provides specialty-matched, expedited or standard medical reviews that address diverse coverage disputes, such as:

• Medical Necessity

• Pre-Surgical Authorizations

• Hospital Admissions

• Length of Stay and Level of Care

• Cosmetic Treatments

• Transplantations

• Experimental Procedures

• Investigational Procedures

• Procedural Coding

• DRG Provider Reimbursement

Coverage disputes are addressed throughout all levels of the appeal process.  Medical reports are provided in the precise format as requested by the client.

Peer Reviewer Panel

NMR’s panel consists of more than 700 medical specialists nationwide.  All reviewers are in active practice and are fully credentialed according to URAC standards.  Our physician reviewers are boarded by either the American Board of Medical Specialties (ABMS) or the American Osteopathic Association Bureau of Osteopathic Specialists (AOABOS) which incorporates all specialties and sub-specialties.

Determinations

NMR provides evidence-based determinations utilizing:

• Peer-reviewed medical scientific literature

• Established clinical professional consensus guidelines

• Health benefit plan language

• Regulatory compliance within the agency of jurisdiction