Who We Are
About Us
Founded in 2004, Claims Eval is a National Provider of Peer and Utilization Review Services providing services to the Workers’ Compensation, Disability, Group Health and Behavioral Health markets. We utilize nationally recognized evidenced-based guidelines to issue decisions for a variety of clients including, but not limited to carriers, third party administrators, managed care organizations and self-insured employers offering them an extensive knowledge of state and federal guidelines. Claims Eval is nationally accredited through the Utilization Review Accreditation Commission (URAC), which includes Comprehensive Independent Review Organization (IRO) and Work Comp Utilization Management (WCUM) certificates. We have acquired multiple state licensures to perform external IRO reviews on behalf of state, commercial and governmental agencies. Claims Eval also offers SBE and LGBTQ diversity certifications.
Physician Network
Our physician network of over 1200 board certified physicians encompasses a broad spectrum of specialties throughout the 50 states allowing for specialty matching where appropriate. All physicians participate in our ten point credentialing program which includes background checks and verification with the National Practitioners Database (NPDB), have a minimum of five years of medical experience, are US licensed, board certified (as applicable) and are in active practice. We value our partnerships with our physicians and the quality and integrity of their reviews.
Proprietary Technology
Claims Eval Review Tracking System (CERTS) is our proprietary, web-based, secure, software designed for ease of use for physicians and clients alike. We utilize this custom software to receive and monitor case assignments and provide status updates. CERTS has the ability to track turnaround times, decisions/outcomes, late cases, reviewer data and is exportable into a variety of reporting formats including ad hoc based upon our client’s needs. Many of our clients opt for Electronic Interfaces (API and EDI) for ease of use. We maintain the highest level of security within our production and development portals which are HiTrust, SOC2, ISO27001, HIPAA and SAS70 compliant. Our data is redundant in two separate states to ensure a smooth transition should there be a need to execute a Business Continuity Plan.
Mission
Claims Eval’s mission is to assist our clients in creating Medical Reviews that are tailored to their need in the evolving requirements of state and federal guidelines. We pride ourselves on our focus on the three essentials of the Peer and UR process of quality, timeliness of responses and defensible evidence-based decisions.
Corporate Giving
Rainbow Chamber of Commerce
Alliance of Women in Workers’ Compensation
Outword Magazine
Rainbow Risk Alliance