BHM, serving as an outsider to your organization, offers expertise that is independent of the health plan, the hospital, and the patient. 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.
Building Trust and Confidence
This level of service builds trust and builds 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.
6 of the top 10 largest health plans* entrust BHM for behavioral health peer reviews.
Behavioral Health & Medical Reviews
Medical Chart Review
Physician Advisory Reviews
BHM ensures a high degree of confidence by regulators, organizations and consumers in the evaluation process.
BHM builds an extensive array of practicing, board-certified specialists, including behavioral health specialists, physicians, medical sub-specialists, experts in pharmacology and other supporting disciplines, and individuals well versed in Medicare and Medicaid requirements. Moreover, BHM has the administrative capacity to train specialists to appropriately review claims and to perform internal audits to ensure the physician reviewers are producing quality reviews.
* Ranked by total number of members in the first quarter of 2016