HHC Group Independent Medical Review New

Serving The Business-To-Business Health Insurance Community

Our Medical Director and Unitization Review Nurse Supervisor (RN) oversee independent medical reviews, and they apply a stringent quality assurance process. They ensure every report answers pertinent questions, that appropriate medical guidelines are referenced, and that the contents of the report are easily understandable – not only by trained medical professionals, but by a layperson. Additionally, all state-assigned cases are also reviewed by our legal counsel to ensure we meet all of the state's requirements.

By Qualified Medical Professionals. HHC Can Help.

We have assembled a team of highly-qualified, credentialed professionals including board-certified physicians, physical therapists, psychologists and other professionals, individually vetted using stringent guidelines to ensure their fitness for rendering decisions. As a result, our team includes among the most respected medical professionals in their respective fields.

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Timely Turnaround. HHC Can Get the Job Done.

Sometimes reviews need to be expedited due to a patient's treatment plan – such as when surgery is required or a high-cost drug is prescribed. For these types of urgent peer reviews, our reviewers are available 24/7, and we can provide reviews with same day, one-day, two-day, or three-day turnaround.

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Objective, Impartial, Unbiased. Let's Get Started.

We provide independent medical reviews in a variety of circumstances and for different types of clients. In all cases, we ensure an objective analysis of the patient's medical circumstances, such as:

When a patient/plan member appeals the decision of his or her insurance company to access care or medication
When a payer wants to ensure the most appropriate and cost effective approach for a complex medical condition
When a payer, such as a workers' compensation plan, wants to determine responsibility for coverage or when a patient can return to work

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Maximizing Client Savings Since 1995

H.H.C. Group is uniquely well qualified to provide this service given its:

26+ years of experience successfully negotiating settlements on medical bills on behalf of payers nationally;
Highly experienced, attorney, licensed health insurance adjustor negotiators;
Proprietary database and access to multiple published databases;

HHC Group Claims Negotiation Repricing insurance filing

INDEPENDENT MEDICAL REVIEW RESOURCES

PEER REVIEW PANEL NEWSLETTER JULY 2022

Founded in 1995, H.H.C. Group began providing Independent Peer Reviews in 2004. We received our URAC accreditation as an Independent Review Organization (IRO) that same year. Many insurers and most states require that the IROs with which they work be accredited. We are URAC accredited to conduct both Internal and External reviews.

DEPENDENT CARE SERVICES CASE STUDY

23-year-old female. Blind, with Lyme disease, Osteoporosis, HHV-6, Uveitis, Juvenile Idiopathic Arthritis, and Bartonella. Lives in a private home with her mother, who acts as her informal helper. Cannot cook, has difficulty eating and drinking as she had difficulty lifting or using her upper extremities. Receives weekly IV infusion and requires aid when going to her doctor's appointments.

INDEPENDENT MEDICAL REVIEW