Claims Eval maintains a national peer review panel of fully-credentialed, licensed, board-certified physicians who are currently in practice and keeping abreast of new developments and standards of care in their fields. They are committed to providing objective, defendable, evidence-based, peer-to-peer consultation surrounding medical necessity, causality and appropriateness of care.
When a medical necessity review is requested, a Peer Review Physician who is state licensed and board certified in the appropriate specialty is selected to provide an objective, defensible, evidence-based medical assessment of the diagnosis, origin and/or treatment of an injury. Reviews may include treatment solutions, relatedness to injury, appropriateness of care, and future treatment needs.
Our comprehensive Physician credentialing process includes a thorough review of medical licensing, (board certifications and professional experience, education) and professional experience. Though requirements vary by speciality, Claims Eval Peer Review Physicians are board-certified, licensed, actively-practicing professionals who maintain continuing education requirements in their fields, have no licensure revocations, suspensions or limitations, and no sanctions or disciplinary actions on record. This process ensures that Claims Eval maintains a panel of experts on safe, efficient and effective standards of care.
Claims Eval’s reputation is built on the quality of our peer review panel, many affiliated with the most prestigious medical centers in the country. To ensure the quality of our review process, Claims Eval repeats the credentialing process on each doctor, dentist and licensed health care professional on an annual basis and provided continual training in utilization review, HIPPA, evidence based medicine and regulatory guidelines.