Medical peer review is an extremely important task in the overall claim settlement process for any insurance company. If you are an insurer or a medical professional who needs to analyze medical documentation and peer review medical cases, you need our managed outsourced medical peer review services.
Our medical peer review services are ideal for insurance organizations, physicians, and law firms who deal with complex care management issues, liability claims, sentinel events, workers' compensation cases, etc. Over the years, we have worked with several commercial Group Health companies, Medicare & Medicaid companies, and Pharmacy Management companies to provide prospective, retrospective, and concurrent peer-to-peer reviews.
Our Medical Peer Review Services
With access to a worldwide network of medical board-certified and practicing physicians, we work with professionals from multiple specialties and sub-specialties. Thus, we are one of the most accomplished medical peer review services providing company out there.
Our medical peer review services help you receive access to credible, totally unbiased evidence-based opinions and formulation of treatment plans and medical insurance cover. This allows us to address extremely specific questions about medical preauthorization, treatment plans, disability duration, return to work ability, pre-existing medical conditions, etc. Our services include -
Group Health Medical Peer Review
FWS offers a whole range of services for group health organizations, running on government and commercially sponsored programs. Our services are ideal for medical appeals, provider quality, SIU, financial integrity of offerings, etc. We offer an independent medical peer review process which includes -
- Determining Medical Necessity
- Experimental/ Investigational Review
- Standard of Care Review
- Plan Language Review
- Stay Length Review
- Quality of Care Review
- Resource Utilization Review
Pharmacy Benefit Management Peer Review
Pharmacy benefit managers or PBMs regulate and manage prescription drug benefits for most health insurers, large-scale employers, Medicare Part D drug plans, and payers. Our pharmacy benefit review services allow payers with increasing workloads to receive more opportunities to reduce drug costs and enhance operational performance.
Medicare Peer Review
Over the years, we have excelled at medical peer review services for Medicaid/Medicare. We work with our clients to provide 100% coverage for after-hours, weekends, and holidays while completing medicare related peer reviews within the stipulated time. We comply with all NCQA and contractual regulations as well.
Disability Peer Reviews
As your medical peer review service provider, we focus on a variety of different functions and an employee's ability to return to work. We offer an entire suite of disability review services, including -
- Review of Independent Medical Exams (IME) conducted across the country
- Imaging Studies for assistive IME processes
- Functional Capacity Evaluations (FCE)
- FMLA Assessments
- Retirement Disability Reviews
Our unique offerings are backed up by a crack team of board-certified radiologists and neuroradiologists. Our resources are specialized in multiple domains such as MRI, X-Ray, Arthrogram, CT & Bone Scan, Mammogram, etc.
Workers Compensation Peer Reviews
Our processes are URAC-accredited when it comes to utilization management for worker compensation peer reviews. We follow ODG, ACEOM, and other relevant state-specific guidelines and we understand the nuances of worker compensations.
Our nationwide network of licensed peer review physicians further ensures that every single aspect of a workers' compensation claim is clinically reviewed. Our services include -
- Compensation Utilization Reviews
- Independent Medical Exam (IME) Reviews
- Peer Reviews for Worker Claims
- Functional Capacity Evaluation (FCE) Reviews
- Impairment Rating Reviews
Our Medical Peer Review Process
With our expertise and innate ability to understand every single client requirement, Flatworld Solutions is uniquely poised to deliver any external peer review services you might need within record time. Our peer review process consists of the following steps -
01. Data Sharing
The client sends us the manuscripts and documents that need to be reviewed via an independent peer-review process
02. First Check and Feedback
The panel of experts at FWS helps check the documents and provide feedback on the ideas and research techniques mentioned within
03. Feedback Shared
Once we have reviewed the entire document and are satisfied with the methodology and its reproducibility, our feedback is then incorporated into your peer review process
All our results and findings are collated in easy-to-understand reports which allow our clients to quickly glance through and decide on the further course of action
Other Services You Can Benefit From
Why Choose Flatworld Solutions for Medical Peer Review Services?
As your partner of choice, FWS helps to solve modern-day problems and deliver results almost instantaneously. Here are a few reasons why you should choose our services -
With us, you gain the ability to work with credible, medical board-certified, and practicing experts in the medical field of your choice.
We offer the right package which covers the number and type of cases you need to be reviewed. This ensures adequate evaluation time for the medical peers and spares you unnecessary worry and expense.
According to the requirement, we also offer virtual practitioner hearings based upon individual techniques, skill levels, and knowledge allowing instant peer-review.
Our easy-to-interpret reports factor in all variables and provide criteria-based ratings, collate definitive findings. We offer feedback for performance issues while identifying scopes for improvement.
Regular Post-review Support
Once the review has been submitted, we can still organize conference calls and other requested interactions with the professional staff for further clarifications.
For your peace of mind, our processes and reports comply with OPPE, FPPE, and other government accreditation and regulatory requirements.
Client Success Story
FWS Provided Medical Transcription Services to a Team of Australian Radiologists
Our medical transcription team provided high-quality and accurate medical transcription services to a group of radiologists from Australia.
FWS Provided Medical Billing Services to a US-based Firm
We provided end-to-end medical billing services to a medical billing firm based out of Maryland, USA.
Outsource Medical Peer Review Services to Flatworld Solutions
I want to thank you for the great job you are doing. I am looking forward to our continued relationship and growth.Owner/President, Medical Billing Solutions Company, California, USA More Testimonials »
Over the years, the hallmark of our services has been our timely, result-oriented, accurate, and evidence-based reviews from a nationwide pool of specialized physician reviewers and relevant healthcare professionals. Whether you have an urgent requirement or would like to further explore how our offerings can change the way you function, we want to hear from you.
Contact us right away and our team will respond as soon as possible to further discuss our offerings.
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