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Independent Medical Reviews and Evaluations

Independent Medical Reviews

Independent Medical ReviewsEvery 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 ProfessionalsWe 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.

Timely TurnaroundSometimes 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, UnbiasedWe 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:
  • 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
About Our ProcessOur 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.

Independent Medical ExaminationsHHC Group offers high quality Independent Medical Examinations (IMEs) for cases requiring an examination by a doctor or other licensed healthcare profession to help answer specific legal or administrative questions related to workers compensation or disability claims.

Performed By Qualified Medical ProfessionalsHHC utilizes only Board Certified specialists who are experienced IME examiners. All have been in practice for at least 5 years and have been thoroughly vetted to ensure they will provide high quality, unbiased reports.

Our Proven ProcessWe've design the process to make it as easy for our clients and their employees. You just by filling out the 1 page HHC IME Authorization form, provide the medical records and questions to be answered and approve the charges prior to the exam. We confirm each appointment with the patient, client and physician by phone, letter and email, and provide translators, transportation and even overnight accommodations should the need arise. We even call the patient 48 hours prior to the exam and then check on the day of the exam to make sure they arrived. Of course, our Utilization Nurse Supervisor and Medical Director review each report to ensure that all questions have been fully answered.

Functional Capacity EvaluationsHHC Group also offers administration of Functional Capacity Evaluations (FCEs) used by physicians, case managers, and employers to transition injured workers from disability to function and employment. An FCE is a series of tests measuring physical strength, ''range of motion'', stamina, and tolerance to functional activities, including lifting and carrying. FCEs can be used to evaluate work tolerance, and the necessity for work restrictions

Our Proven ProcessAs with IRs/URs and IMEs, we use only qualified, vetted physicians and other professionals to conduct the evaluations. Again, all a client has to do to order a FCE is fill out the Authorization form and approve the payment amount. We follow the same scheduling and notification process as for IMEs to ensure the evaluation takes place and the report is forwarded to the client on a timely basis.