Welcome to Claims Eval

Group of friendly doctors

Claims Eval Inc. is a URAC accredited Independent Review Organization (IRO) with a national footprint. We provide independent, utilization reviews to ensure medically necessary, and quality health care.

We have a national panel of medical experts to help identify appropriate treatment which conform to state and national mandates.

What We Specialize In

  • Medical Necessity Reviews
  • Causation Reviews
  • File/Chart Reviews
  • Hospital Inpatient Care Reviews
  • Medicare Set-Aside (MSA) Reviews
  • PBM and Pharmacy Reviews
  • Medical Director Services
  • Patient Protection and Affordable Care Act Reviews

Who We Serve

Female doctor looking at computer

As an IRO, we work with Utilization Review companies, Utilization Management companies, hospital Utilization Management departments, Workers’ Compensation and Group Health insurance companies, disability management and medical cost containment companies, third-party administrators, and self-funded employee benefit payors. We provide state-mandated independent reviews for workers’ compensation and group health plans addressing medical necessity, investigational/experimental treatments, clinical trial participation, and benefit coverage matters.

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Claims Eval is an Accredited Independent Review Organization

Physicians Wanted

Are you interested in working with Claims Eval as a Peer Review Physician?

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Claims Eval is a member of the National Association of Independent Review Organizations