Category: Medical Peer Review

MOS Medical Reviews November 19, 2021 0

A medical peer review for health plans is usually conducted to determine if a medical claim denial should be upheld or not. This review is performed by a physician that belongs to the medical specialty relevant to the […]

Julie Clements August 6, 2021 0

Peer reviews can have a major impact on the outcome of a medical claim. These reviews are paper-based evaluations that are prepared by credentialed, trained and experienced physicians. The objective of the peer review is to provide […]

Julie Clements June 30, 2021 0

Employers in different industry sectors need to be aware of the official regulations issued from time to time to stay compliant and ensure workplace safety for their employees. Workers’ compensation attorneys also […]

MOS Medical Reviews January 11, 2021 0

Insurance peer review is an important process when determining the claimant’s eligibility for medical insurance coverage. It helps ensure that the coverage is provided for medically necessary services and there is no […]

Julie Clements November 18, 2020 0

Peer reviews are utilized by healthcare providers and insurance companies to obtain detailed, evidence-based reports that provide objective and accurate answers to case-specific questions. The reports are prepared by physicians […]

Rajeev Rajagopal November 16, 2020 0

Medical peer reviews are crucial for clean health insurance coverage. In case of a doubt or ambiguity regarding a medical insurance claim, a medical peer review may be conducted by a physician employed by […]

Julie Clements November 6, 2020 0

Insurance denials are not something new and specific reasons for denials will be outlined in the EOB or the Explanation of Benefits document the insurer sends to the claimant. It helps prevent insurance fraud and control […]

Peer reviews are of different types in healthcare. In a healthcare organization, peer review is used to study physician performance and ensure that providers skills are maintained at the highest standards so that patients receive the […]

Rajeev Rajagopal March 2, 2020 0

Medical peer reviews are very important from the point of view of health insurance coverage. Though health plans receive a great deal of ire from providers and patients alike for claim denials based on the peer review process, it cannot be denied that such reviews are necessary to combat fraud and contain healthcare costs. Mostly, confusions […]

Rajeev Rajagopal December 16, 2019 0

Updates to ERISA (Employee Retirement Income Security Act) that came into effect on April 1, 2018, are relevant to disability claimants, disability insurance carriers, insurance lawyers, and companies offering medical peer review services among other entities. This final rule is aimed at strengthening consumer protections for private sector employees who make claims for benefits from […]

 

     

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