Pennsylvania Certifies HHC Group as a Utilization Review Entity

August 18, 2016 The Pennsylvania Department of Health has certified HHC Group as a Utilization Review Entity for Pennsylvania Managed Care Plans The Pennsylvania Department of Health has certified H.H.C. Group as a Utilization Review Entity for Pennsylvania Managed Care Plans. The State has also certified HHC Group to conduct External Grievance Appeal Reviews received from consumers and providers of health service decisions by Managed Care Plans. The State has begun assigning HHC Group cases for review.

Utilization Review Entities or Independent Review Organizations (IRO) provide peer review services when insurers deny health insurance claims. The purpose of these reviews is to determine if a service is medically necessary, medically appropriate, experimental or investigational. The Affordable Care Act requires insurance companies to contract with at least three IROs that are nationally accredited.

HHC Group is a URAC accredited IRO. URAC (formerly the Utilization Review Accreditation Commission) is a nonprofit organization promoting healthcare quality by accrediting healthcare organizations. URAC's IRO standards "assure that organizations that perform this service are free from conflicts of interest, establish qualifications for physician reviewers, address medical necessity and experimental treatment issues, {and} have reasonable time periods for standard and expedited reviews, and appeals processes."

HHC Group provides Internal and External Independent Peer Reviews for insurance companies, health maintenance organizations, self-insured companies and ERISA plans. The team overseeing the review process utilizes its combined 125 years of healthcare experience to ensure that every review fully answers all questions being asked, cites the appropriate medical guidelines, and is clearly written and grammatically correct.

HHC Group serves a Utilization Review Agency, Licensed\Certified\External IRO, Private Review Agent or Licensed Medical Claims Review Agency in 25 states.

About HHC Group

HHC Group is a leading national health insurance consulting company providing a wide range of cost containment solutions for Insurers, Third Party Administrators, Self-Insured Employee Health Plans, Health Maintenance Organizations (HMOs), ERISA and Government Health Plans. HHC Group utilizes a combination of highly skilled professionals and advanced information technology tools to consistently deliver targeted solutions, significant savings and exceptional client service.

HHC Group's services include Claim Negotiation, Claim Repricing, Medicare Based Pricing, DRG Validation, Medical Bill Review (Audit), Claims Editing, Medical Peer Reviews/Independent Reviews, Independent Medical Examinations (IME), Case Management Utilization Review, Data Mining, Disease Management and Pharmacy Consulting. H.H.C. Group is one of 46 URAC accredited IROs.

For additional information about HHC Group and our services, visit www.hhcgroup.com or contact Bob Serber at rserber@hhcgroup.com or 301-963-0762 ext. 163