We provide physician-level initial, appeal, concurrent, prospective, and retrospective medical peer to peer reviews for commercial Group Health, Pharmacy Benefit Management, Medicare & Medicaid, and Workers' Compensation cases.
With one of the largest and most competent reviewer networks of physicians and allied health professionals in the industry, we pride ourselves on the clinical excellence that we provide our clients. In all facets of our work, we are guided by our company belief statement- we believe every patient should receive quality healthcare.
AMR provides a broad range of services to group health organizations, for both commercial and government sponsored programs. Our physician and allied health reviewers assist in decision making for UM and Appeals’ Depts, provider quality, SIU, financial integrity and more. Our clients frequently request short turnaround times, peer calls and high-volume, special projects within a short period.
Pharmacy Benefit Management
Our pharmacy benefit review services and customizable technology allow payers with continually growing workloads to get a quick and independent outcome. AMR also provides PBM clients greater opportunities to reduce prescription drug costs through enhanced accountability, options, and operational performance.
Medicaid / Medicare
AMR excels in delegated Medical Director services for Medicaid/Medicare. We provide coverage after hours, weekends, and holidays as an adjunct to a client’s internal MD staff while complying with all NCQA and contractual regulations.
URAC-accredited in utilization management, AMR understands when to deploy the appropriate clinical guidelines by state. ODG, ACEOM and state-specific guidelines are utilized by our physician consultants who understand the nuances of workers’ compensation.
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Our platform assists your operations with quick processing, data mining and specialized reporting. Customizable to your workflows and needs, the portal makes submitting, tracking and reporting on reviews of all types intuitive. Contact us to schedule a demo:Learn More
Medical Peer Review Services
Quality of Care for Healthcare Systems and Providers
AMR provides benefits to both the clinical and administrative teams within a group healthcare organization. For clinical teams, AMR’s expertise and technology provide a consistent, evidence-based perspective of the quality of clinical care. In addition, our HITRUST CSF certified review platform technology streamlines the operation for all parties. With one of the largest physician review networks in the industry, we can specialty and state match physician reviewers for a range of quality of care reviews.
Utilization Management Program Support
AMR supports UM teams at all levels, from pre-service assessment through third-level, final and binding review. Our panel of board-certified specialists can review for medical necessity and experimental/investigational status based on plan criteria, current medical literature or both. We frequently provide case rationales in varying reading levels to comply with state standards.
Medical Director Coverage
As a URAC-accredited IRO with a physician network covering a wealth of medical specialties and sub-specialties, AMR can meet your medical necessity review requirements in an interim capacity. Our physician consultants are equipped to serve you when you are short-staffed.
Billing and Coding
Clients in various industries utilize AMR’s billing & coding experts, as well as physicians, to assess service codes for accuracy, medical necessity or fraud. AMR can facilitate reviews using a combination of medical and billing professionals, or strictly one or the other.
Third Party Administrators (TPA)
By furnishing an independent medical review service, third party administrators provide an important value added service. Their customers will not have to incur the cost of implementing a process that is not part of their core competency. At the same time, a third party administrator can utilize an IRO as part of a risk management strategy.
Healthcare Consulting Organizations
AMR’s nationwide physician panel covering all major boarded specialties, capability to customize workflows on a client-by-client basis, and industry defining stewardship are only a few of the reasons HCO’s turn to AMR for their clients' physician-level peer review needs.
Case Management Companies
Automating the independent review process brings greater efficiency to the entire claims practice. By partnering with AMR, case management companies can ensure claims management teams are using the same automated platform, allowing greater consistency throughout the life of the claim. This also allows for uniform reporting for identifying best practices and more efficient budgeting.
Special Investigation Units (SIU)
URAC-accredited as an Independent Review Organization (IRO) for internal and external reviews, AMR physician consultants attest to their impartiality in reviewing medical records for fraud, waste and abuse. Our national network is boarded and specialty-matched to ensure a complete and clinically appropriate assessment.
Advanced Medical Reviews took the time to understand our business needs and has surpassed our expectations with the results they delivered.
The thoroughness and precise attention to medical reviews they provide is simply unparalleled. Moreover, we appreciate their fast turnaround time. Reviews are well-written and give exactly the information we need.
As a TPA who needs to deliver cost containment features to clients, and who also needs to satisfy reinsurer requirements, from pre-certification to the most involved high risk large case review services, we have found Advanced Medical Reviews to be pro-active and knowledgeable in all activities.
I love how receptive the staff has been. Whatever need we have, and we have a lot, they have been able to create workflow that makes working with AMR seamless. We have a lot of specialty cases and we appreciate the huge network of reviewers AMR has to offer. With our short turnarounds times, we feel confident that we can send a case to AMR and they will have the reviewer available and back to us on-time.-Anonymous, Lead Physician Advisor Support Representative
What can I not say about the portal? It is so easy to use it literally takes me less than two minutes to submit a case versus other vendors that take up a lot more of my time. What I really appreciate about the portal is the scoreboard; knowing the exact stage my case is in provides me a level of comfort. AMR’s portal is much nicer and friendlier than the other IROs I have worked with.
I enjoy the simplicity of the software, the stellar customer service, and the attentiveness of our business owner/ project manager. The reviews are almost always received back before the due date and time. The customer service team is attentive, kind and professional when communicating with our staff members.-Lindsay Welch, Clinical Business Analyst