National, utilization management organization with products spanning all state/federal insurance lines.
Our physician reviewer panel consists of ~1,400 physicians holding licensure across the US with a wide range of specialties to address your every need.
Claims Eval conducts reviews in all US jurisdictions making us adept in state & nationally recognized guidelines, as well as jurisdictional mandates. When external review is sought, our decisions are upheld 98% of the time — exceeding the national standard.
Successful, rapid return to pre-injury state is achieved through the delivery of evidence-based medical care. Our reviewers assess compliance toward that goal and outcome. When care deviates from that course, the reviewers can assist in identifying potential on-going and future treatment.
Behavioral Review Market
Our panel includes sub-specialists in Child/Adolescent Psychiatry, Geriatric Psychiatry and Addiction Medicine. Panelists have extensive experience managing and reviewing Eating Disorder services and ABA Therapy. We provide services for Commercial Insurance and Government Services, and can review for the entire continuum of care from IP through OP, including CBS, ABA Therapy, Transcranial Magnetic Stimulation, Electroconvulsive Therapy, and Psychological/ Neuropsychological testing.
Medical reviews conducted by actively practicing, specialty matched reviewers assessing compliance with disability standards (i.e., MIRS, SGA, CDR, etc.). These claims require a myriad of aspects including employability, short-term disability and long-term disability.