Independent Medical Reviews
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 has earned accreditation from URAC, formerly the Utilization Review Accreditation Commission, as an Independent Review Organization for both Internal and External reviews.
In more than two dozen states, we're among a handful of companies authorized by the states to provide these types of reviews.
By Qualified Medical Professionals
We have assembled a team of highly-qualified, credentialed professionals including board-certified physicians, physical therapists, psychologists and other professionals, 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.
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 same day, 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 Unitization Review Nurse Supervisor (RN) 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.
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