Every Breed Of Specialist For Every Type Of Review
For claims that require an independent determination of medical necessity, causation, medical appropriateness, general acceptance, or ability to return to work, HHC offers internal and external independent medical reviews. And with a network of medical professionals in almost every medical specialty, we're ready for virtually any type of review that comes our way.
HHC Group has earned accreditation from URAC, formerly the Utilization Review Accreditation Commission, as an Independent Review Organization
. In more than two dozen states, we're among a handful of companies authorized by the states to provide these types of reviews.
Medical Reviews From Qualified Medical Professionals
At HHC we assembled a team of credentialed medical professionals including board-certified physicians, registered nurses, physical therapists, and psychologists, individually vetted using stringent guidelines to ensure their fitness for rendering decisions. As a result, our team includes among the most respected medical professionals in their respective fields.
Fast Access To Our Reviewers
Sometimes reviews need to be expedited due to a patient's treatment plan – such as when surgery is required or a high-cost drug is prescribed. For these types of urgent peer reviews, our reviewers are available 24/7, and we can provide reviews with one-day, two-day, or three-day turnaround.
Objective, Impartial, Unbiased
We provide independent medical reviews in a variety of circumstances and for different types of clients. In all cases, we ensure an objective analysis of the patient's medical circumstances, such as:
About Our Process
- When a patient/plan member appeals the decision of his or her insurance company to access care or medication
- When a payer wants to ensure the most appropriate and cost effective approach for a complex medical condition
- When a payer, such as a workers' compensation plan, wants to determine responsibility for coverage or when a patient can return to work
Our Medical Director and Director of Medical Review (RN, BSN) oversee independent medical reviews, and they apply a stringent quality assurance process. They ensure every report answers pertinent questions, that appropriate medical guidelines are referenced, and that the contents of the report are easily understandable – not only by trained medical professionals, but by a layperson. Additionally, all state-assigned cases are also reviewed by our legal counsel to ensure we meet all of the state's requirements.