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Health Appeals

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As a URAC Accredited Comprehensive (Internal & External) Review organization, ProPeer is at the forefront of providing clinical review services to health plans, managed care organizations, pharmacy benefit managers, and third party administrators looking to ensure the highest quality and timely appeals process. When plan coverage disputes arise, our clients rely on ProPeer to support their utilization management and appeals by processing effective, accurate independent clinical reviews. We support all levels of appeal for internal, state external, and federal external appeals, as well as various peer review services optimized for enhanced client experience.

ProPeer’s 30 years of clinical review experience provides clients with peace of mind knowing a highly qualified team of clinical reviewers will deliver with speed and efficiency, while never compromising quality.

Propeer specializes in:

State External Review

Licensed in state mandated external review participating states

Federal External Review

Experienced partner in compliancy with: DOL, ERISA, ACA, NAIC Model Act

Internal Appeals/Independent Peer Review Services

  • Medical Necessity
  • Pharmacy/Formulary
  • Experimental & Investigational
  • Independent Dispute Resolution
  • Recission
  • Plan/Policy Review
  • Panel Review
  • Three Party Dispute Resolution

Appeals Review Services Customized To Meet Your Needs

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