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Accreditation

Excellence through Our
Commitment to Accountability

ProPeer has spent the last 30 years strengthening a commitment to quality and accountability. Our credentials and accreditations speak to our guarantee by providing the highest quality and most timely clinical reviews.

ProPeer is proudly accredited through URAC, the gold standard of accreditation for the healthcare industry. In June 2000, ProPeer was a beta test site for URAC to assist with their development of the Independent Review Organization (IRO) accreditation program, and subsequently became one of the original five organizations to earn URAC Accreditation under the IRO program and has successfully re-accredited every accreditation cycle since then.

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ProPeer's processes align with those of URAC to ensure ProPeer:

Is up to date on all  federal and state regulations, organizational processes, compliance requirements and data securitiy standards.
Works with appropriately licensed and credentialed peer reviewers who are current on the latest medical standards and technologies.

Ensures consistency, efficiency and accuracy in our operational process for internal and external review.
Is equipped to deliver three types of utilization review services: retrospective, concurrent, and prospective.

Features expansive review panels of hundreds to thousands of experts who can provide access to all recognized specialties and subspecialities.
Is executing a consistent quality management program to ensure inter-rater reliability and monitoring of complaints
Provides expertise in experimental and investigational reviews and are current on the accepted standards of care.
Provides advanced, ongoing education and training to ensure the use of reviewers who are knowledgeable about the most current peer-reviewed literature and evidence-based medicine.
Adheres to standards and guidelines intended to avoid issues of corporate conflicts and inherent bias.

ProPeer Earns Three-Year NCQA Utilization Management Accreditation

ProPeer has been awarded a three-year Utilization Management (UM) Accreditation from the National Committee for Quality Assurance (NCQA), one of the nation's most respected independent authorities on healthcare quality. This distinction reflects ProPer's ongoing commitment to consumer protection, service excellence, and continuous performance improvement.

NCQA Utilization Management Accreditation is a comprehensive quality assessment program that evaluates how organizations manage clinical review processes to ensure appropriate, evidence-based care decisions. Earning this accreditation affirms that ProPer's utilization management practices are rigorous, consistent, and aligned with current regulatory and industry standards.

The accreditation process examines performance across critical areas, including quality improvement initiatives, collaboration with clients, protection of member confidentiality, engagement of qualified clinical professionals, fair and timely determinations, appeals management, and the measurement of member and provider experience.

A Meaningful Validation for Clients
Achieving NCQA accreditation demonstrates that ProPeer's utilization management program operates with transparency, clinical integrity, and accountability. Clients can be confident that reviews are conducted according to nationally recognized best practices and supported by a strong governance framework.

This recognition further strengthens ProPeer's established compliance infrastructure and underscores the maturity of its operations. It validates the organization's physician-led clinical review model and reinforces its commitment to delivering quality-driven outcomes for health plans, third-party administrators, employers, and workers' compensation organizations nationwide.

By integrating accredited utilization management standards into its peer review model, ProPer continues to simplify complex clinical review programs, ensuring decisions are clinically sound, timely, and defensible, while maintaining a clear focus on quality and client

NCQA Utilization Management Accreditation Seal
ProPeer strives for excellence in all areas because clients trust our solutions for their managed care and clinical review programs.
When selecting a clinical review partner, the choice goes well beyond the reviews and reports – the quality behind the solution directly impacts the outcome for patients, providers, and payors. Our goal is to offer the highest quality and trusted solution to each and every client.

A clinical review partner you can trust

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ProPeer's mission is to provide innovative, efficient, and compliant solutions in managed care with a vision of unmatched quality balanced by unparalleled service.

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