MEDICAL PEER REVIEW

Key elements in the medical review process are physician specialist clinical knowledge, application of specific peer-reviewed literature, and adequate patient information. And the ability of the consultant to clearly communicate their findings and understanding of the patient being reviewed is paramount. The response should be customized in an easy to read well-written narrative format, without using a numbered standard format, as seen many times today. The physician reviewer should be practicing, board certified and should be at an “arms length” from the review company to give an objective and unbiased review.

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HealthClaim Review® has distinguished itself by its rapid turnaround times without sacrificing quality for speed. Phone calls are answered live during business hours to provide a “real time” client response. Benefit coverage as determined by the plan document is considered along with medical appropriateness and possible investigational status.

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​Peer-to-peer calls are made by the actual medical specialist who reviewed the case, rather than an in-house retired medical director who may have limited specialty knowledge of the patient’s medical condition.