H.H.C. Group: National Leader in Independent Medical Reviews

June 16, 2025 Internal and External Reviews That Keep Payors Compliant, Decisive and Protected

Medical denials are on the rise and today's payors are facing tougher compliance scrutiny than ever before. From complex treatment reviews to urgent appeals, one wrong call can trigger fines, lawsuits or reputational fallout.

HHC Group delivers independent, fast, clinically sound reviews that keep you compliant, confident and in control.

HHC Group conducts Internal Medical Reviews (IMRs) nationally and is approved to provide External IMRs in 33 states. That dual capability gives our clients total coverage and peace of mind from the first question to final resolution.

In most states, once a coverage denial occurs, insurers must refer the case to the state, which assigns it to an approved IRO.

In others, insurers can contract directly with an IRO like HHC Group—and we are fully equipped to support both pathways. Additionally, numerous insurers have HHC Group help them determine if they should cover a treatment requested by a plan enrollee.

The Hidden Risk Behind Medical Disputes

Coverage denials are becoming more frequent and more legally fraught. As insurers and TPAs lean into AI-based tools and automated decision engines, the margin for error grows. Denials issued too quickly or without clinical rigor are increasingly challenged by members, regulators and courts.

When a dispute gets out of control, the consequences can include:

• Compliance breaches that lead to investigations or fines.
• Litigation risks that drain resources and damage credibility.
• Unpaid claims ballooning into larger financial liabilities.
• Reputation loss that undermines confidence with plan participants.

Having a medical review process in place isn't enough. It must be structured, defensible and trusted—internally and externally. That's where HHC Group comes in.

Internal Reviews: Nationwide Coverage. Unmatched Expertise

HHC Group conducts Internal IMRs in all 50 states, supporting insurers and TPAs in making critical decisions about medical necessity, experimental treatments and clinical appropriateness.

When your internal team lacks a specific specialty or when time is short and objectivity matters HHC Group's board-certified experts step in with fast, unbiased, evidence-based opinions that support plan integrity and protect against downstream risk.

These reviews are essential for:

• Preventing costly coverage errors.
• Responding quickly to complex or high-stakes claims.
• Strengthening claims defensibility before external escalation.

HHC Group is your frontline clinical decision support.

External Reviews: Trusted in 33 States and Growing

In addition to national internal review capability, HHC Group has been approved to conduct External IMRs in 33 states, a recognition of clinical excellence, compliance standards and operational reliability.

External reviews are typically assigned by state regulators when a member challenges a denial. These reviews carry legal weight and must be handled with precision. HHC Group is proud to be a trusted partner to these states, providing fair, balanced and fully documented reviews that meet or exceed state requirements.

Whether it's a state-assigned review or a direct contract in one of the few states that allow it, HHC Group ensures that disputes are resolved cleanly, with no regulatory gaps or friction.

Why Payors Trust HHC Group

Every review HHC Group conducts—internal or external—is built on a rock-solid clinical foundation:

• Unshakable Clinical Objectivity: Every review is evidence-based, unbiased and URAC-accredited for full regulatory compliance.
• Elite Credentialing: Only board-certified, licensed specialists across 84 clinical specialties review cases.
• Rapid Turnaround Times: Speed that protects plans from dangerous delays and litigation risks.
• Gold-Standard Accreditation: URAC certification ensuring top-tier review quality.

HHC Group puts decisions in the hands of real medical professionals, not algorithms because every case has real-world consequences.

Turn Disputes Into Decisive Wins

What used to be routine coverage decisions are now potential compliance flashpoints. Minor disputes are under legal and regulatory microscopes and outdated processes, slow responses or patchwork expertise can put your entire plan at risk.

HHC Group equips payors with the clinical strength, speed and credibility to stay ahead of the risk and stop disputes before they spiral.

• Internal reviews that defuse problems early and keep decisions aligned with medical necessity.
• External reviews that meet the highest standards across 33 state-regulated programs.
• Seamless support across all plan types, with scalable, expert-driven service.

In today's environment, it's not enough to stay compliant. You need to lead with confidence.

HHC Group helps you own the process with faster resolutions, airtight compliance and decisions that stand up to any challenge.

If you're ready to take control of your IMR process and put compliance on solid ground, we're here to help. Contact HHC Group today, before the next dispute defines you.