ProPeer provides hospitals, health systems, and payors with independent arbiter services when disputed claims arise without resorting to litigation. The ProPeer system allows for a full review of all documentation quickly and efficiently without compromising quality in order to expedite the delivery of a resolution. ProPeer’s panel of clinical reviewers is comprised of over 4,000 board certified specialties and subspecialties nationwide allowing for seamless specialty match.
ProPeer’s insight into the federally mandated independent dispute resolution process allows ProPeer to assist clients and partners in navigating the regulatory landscape while optimizing results. Our comprehensive suite of services spans both the formal dispute resolution process and informal three-party resolution.
With access to over 1,100 board certified specialties across the US, ProPeer can provide the independent expertise necessary to determine appropriateness of care, medical necessity, experimental/investigational related reviews. We specialize in ensuring quality reviews that meet the standards of accreditation, regulation, and client need.
The challenges faced by medical facilities, hospitals, and community health centers are unique and complex. ProPeer has developed a customized suite of services to address quality of care that aids in the prevention unintended outcomes and medical errors.
Ensuring quality of care and compliancy can be extremely cumbersome and time consuming. ProPeer offers customized solutions that fit perfectly into any quality assessment or audit program. Our team of medical experts help solve problems and deliver results.
ProPeer offers nurse and physician pre-authorizations to include pre-service, concurrent, and post-service medical necessity review. The underpinning of a superior health utilization management program is timing – the ability for patients to receive services quickly and efficiently. ProPeer’s expertise in rush cases ensures clients and patients receive quality outcomes through rapid turn around times.
Whether you are looking for a partner for specialty or non-specialty review services, nurse or physician pre-authorizations, and medical necessity reviews, ProPeer provides timely and accurate reviews that ensure a patient’s continuum of care.
Elimination of potential conflicts of interest including professional, organizational, and/or personal bias inherent to review programs performed or supported with internal reviewers.
Removal of the administrative burden and strain on internal quality assurance/risk management programs by providing efficiency and mitigating the fixed staffing cost of these internal initiatives.
Providing access to a broad range of specialties in instances when facilities’ in-house expertise may be limited.
Objectively monitoring and measuring the quality of care delivered, allowing for benchmarking which can provide the foundation for staff coaching and training.
Providing a systematic and scalable approach ensuring review criteria and results are accurate, reliable which reduces risk by identifying trends and potential issues of clinical staff performance, deficiencies, and errors.
Providing timely, standardized reporting as well as ad-hoc reporting capability improving internal evaluation, review efficacy and streamlining any external reporting mandate to demonstrate compliance quality program performance.