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• Accident & Forensic Investigation Services

• Chart Reviews

• Claims History & Case Reviews

• Coding Reviews

• Disability Claims & Evaluations

• Forensic Medical Reviews

• Functional Capacity Evaluations

• Impairment Ratings

• Independent Medical Reviews

• Peer Reviews

Quality of Care

• Coding & Treatment Issues

• Coverage Criteria Evaluations

• Malpractice Case Histories

• Peer Reviews

• Plan Language Development

• Provider Accounting Reviews

• Quality of Care Reviews

Workers Compensation / Disability

Internal Reviews

• Chart Reviews

• Complete Medical Records Reviews

• Disability Claims & Evaluations

• Forensic Medical Reviews

• Functional Capacity Testing

• Independent Medical Examinations

• Impairment Ratings

• Peer Reviews

External Reviews

• Independent Medical Exams

• Peer Reviews

• Utilization Reviews

Utilization Management

Internal Reviews

• Adverse Determinations

• Adverse Determinations Appeal Reviews

• Appropriate Coding & Treatment

• Benefit Coverage Issues

• Chart Reviews

• Claims History & Case Reviews

• Coding Reviews

• Complete Medical Records Reviews

• Cosmetic Treatments

• Covered Benefit Disputes

• Coverage Criteria Evaluations

• Dental Reviews

• DRG Reimbursements

• Emergency Cases

• Experimental Reviews

• First Level Appeals

• Foreign Language Translation Medical Reviews

• Health Benefit Coverage Disputes

• Hospital Admissions & Length of Stay

• Hospital Accounting/Claims/DRG Reviews

• In/Out Patient Pre-Certification

• Initial Determinations

• Internal Reviews (Initial, Levels I & II)

• Investigational Reviews

• Level of Care & Impairment

• Medical Necessity

• Member Appeals

• Peer to Peer Reviews

• Predetermination Reviews

• Pre-Surgical Authorizations

• Provider Appeals

• Provider Claims Reviews

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

• Reconsiderations

• Second Level Appeals

• Specialty Matched Reviews

• Transplantation Reviews

• Unusual or Disputed Claims Reviews

• UCR Audits

External Reviews

• Consumer Grievance Issues

• External Appeals

• Health Benefit Coverage Disputes

• Hospital Admissions & Length of Stay

• Hospital Accounting/Claims/DRG Reviews

• Grievance Appeals

• Grievance Hearings

• Independent External Reviews

• Level III Appeals

• Medical Necessity External Reviews

• Panel Member Appeals

• Provider Appeals

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

• Thomas Love Medical Necessity External Review Process            

Alphabetical listing for Services...