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Group Health

Claims Eval provides group health peer review services to group health plans, health and wellness plan providers, TPAs and self-funded employer groups. Our Independent Review services comply with all requirements for performing reviews associated with the Patient Protection and Affordable Care Act (PPACA) and PHI. As a URAC-accredited Independent Review Organization, we rigorously ensure that our reviews are free of any conflict of interest.

Advisors join our panel only after their credentials have been independently researched and verified. Claims Eval carefully monitors all US jurisdictions to assess developing sanctions/blemishes/concerns regarding our physicians.

Claims Eval provides two primary types of review: Utilization Review and Quality of Care.

Deliverables include:

• Access to CE’s national network of Physician Advisors
• State match and specialty match options are customizable
• Peer-to-peer outreach to treating physicians where requested
• Sorting and labeling of records
• Quality Assurance review on 100% of referrals
• Reports delivered in client-specific template
• Reviews delivered according to all URAC, federal, state and client requirements