Health Utilization Management

No Surprises Act

ProPeer offers a full suite of services to meet your health utilization management needs. Our services are structured to fit perfectly within any workflow.

ProPeer specializes in services for:

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Independent Peer Review

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.

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Hospital Peer Review

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.

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Quality Assessment & Audit

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 specializes in services for:

Corporate Health - Icon

Commercial
Health

Medicaid & Medicare - Icon

Medicaid/
Medicare

Self Insured Entities - Icon

Self Insured
Entities

Pension & Benefits - Icon

Pension Benefit
Administrators

Hospitals / Health - Icon

Hospitals/
Health Facilities

Patient Care Continuity

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.

Doctors having a discussion at table

ProPeer offers specialty bill review expertise and resources to evaluate appeals and reviews related to:

ProPeer offers specialty bill review expertise and resources to evaluate appeals and reviews related to:

ProPeer’s peer review services aid in:

Conflict-Free
Reviews

Elimination of potential conflicts of interest including professional, organizational, and/or personal bias inherent to review programs performed or supported with internal reviewers.

Administrative
Relief

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.

Specialty
Access

Providing access to a broad range of specialties in instances when facilities’ in-house expertise may be limited.

Quality
Benchmarking

Objectively monitoring and measuring the quality of care delivered, allowing for benchmarking which can provide the foundation for staff coaching and training.

Scalable
Accuracy

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.

Standardized
Reporting

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.

Allow our expert reviewers to take the lead for you.