Claims Eval Inc. is a nation-wide URAC accredited Independent Review Organization (IRO). We provide independent, external utilization reviews to ensure medically necessary, quality health care.

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

What We Specialize In

• External Medical Necessity Reviews
• Peer Reviews
• File/Chart Reviews
• Medicare Set-Asides (MSA) Reviews
• PBM and Pharmacy Reviews
• Medical Director Services
• Patient Protection and Affordable Care Act Reviews

Who We Serve

As an IRO, we work with Utilization Review companies, Utilization Management companies, 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 contractual/administrative matters.

• Read what our clients have to say about us