Peer Review Specialties
Medical Specialty Peer Reviews were initially developed to assist claims departments in reducing cost on improperly coded or billed claims and determine the appropriate treatment given in accordance with Academy guidelines. Independent Medical Reviews have become the industrys standard process for resolving medical appropriateness and billing issues. Independent Medical Reviews can answer virtually any question you have concerning an individual claim or particular provider's billing and practice habits.
When do you need an independent specialty medical review?
- When you question the Medical Necessity of treatment, or proposed treatment.
- When you want to Delegate your UR appeals.
- When you need advice determining if a procedure is Experimental or Investigational.
- When you need assistance determining a Pre-existing Condition as defined by your policy language.
- When you need Proper Coding for a procedure, (as evidenced by patients medical records).
- When you need to correct UCR fees for the actual treatment provided to the patient.
- When you need to establish a proper Utilization Plan for a patients condition and progress.
- When you suspect Up-coding or Unbundling.
- When you need an Independent External Opinion to settle a conflict between you (or your Medical Director) and the Attending Physician concerning any of these issues.
ProPeer Resources currently offers independent medical review services for the following specialties:
- Acupuncture
- Allergy
- Anesthesia
- Cardiology (Interventional)
- Cardiothoracic Surgery
- Chiropractic
- Certified Fraud Examiner (MD & DC)
- Dental
- Dermatology
- Durable Medical Equipment
- Endocrinology
- Environmental Medicine
- ENT-Otolaryngology
- Gastroenterology
- Hematology
- Home Health
- Infertility
- Internal Medicine
- Infusion Therapy
- Immunology
- Neurology
- Neuropsychology
- Neuroradiology
- Neurosurgery
- Nursing Home
- Obstetrics
- Ophthalmology
- Oncology
- Optometry
- Oral & Maxillofacial Surgery
- Orthodontics
- Orthopedics
- Osteopathy
- Pain Management
- Pathology
- Pediatrics
- Periodontics
- Pharmacy
- Physical Medicine & Rehabilitation
- Physical Therapy
- Plastic & Reconstructive Surgery
- Podiatry
- Prosthetics/Orthotics
- Psychiatry
- Psychology
- Sleep Disorders
- Surgery
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