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Prescribing Patterns

Claims Eval provides Peer Review services nationwide, with a rigorous Quality Assurance Program on 100% of files. Our support staff provides readily accessible telephone and consultation support from 6:30 am to 6:30 pm PST.

All of our services include medical sorting & labeling. Each final report includes a chronological listing of medical records, clinical summary and determination for each question, and a rationale based upon appropriate evidence-based guidelines. All Peer-to-Peer attempts and conversations are documented in detail.

In addition to receiving referrals via our secure web portal, we accept referrals via secure email, FTP, or via real-time inbound & outbound integration with clients’ internal referral system.

As part of your individual client profile, your requirements such as jurisdictional/state match, specialty match, peer-to-peer tracking, report templates and TAT can be customized and updated as needed.

Workers Compensation

• Utilization Review/Physician Advisor Services

 

• Record Reviews

 

Pharmacy

•Comprehensive Drug Utilization Reviews

 

• Pharmacy Medication Reviews

 

Disability

• STD/LTD

 

• FMLA/ADA

Auto Liability

• PIP/MedPay

 

• Demand Package Reviews

 

Group Health

• Utilization Review/Physician Advisor Services

 

• Quality of Care

 

Auditing

• External Independent Auditing

 

• Physician Bill Rev & Auditing

 

• Hospital Bill Rev & RAC Auditing