independent review organization

Independent Review Organization

BHM, serving as an outsider to your organization, offers expertise that is independent of the health plan, the hospital, and the patient.

In short, our sole purpose is to use all available expertise to evaluate cases based on the most current evidence-based practices and national, state, or local regulatory guidelines.

Utilization Management

Building Trust and Confidence

This level of service builds trust and confidence that decisions are both rational and equitable. Conducting diplomatic, effective peer-to-peer consults with the attending physician as needed builds stronger provider relationships for your health plan while ensuring all relevant case details are considered when making an appropriate determination.

Utilization management (UM) decisions, made by BHM Healthcare Solutions (BHM) designated reviewers, use nationally recognized criteria and are based only on appropriateness of care and services, including the existence of coverage. BHM does not compensate anyone for denying coverage or service, nor does it use financial incentives to encourage denials or the under-utilization of any needed medical service.

Physician Peer Reviews, peer review partner, physician peer to peer review