A medical peer review is a formal process in which care is reviewed to determine medical necessity. It can provide a means for an independent review organization (IRO) to review all of the documentation associated with the case to render an appeals decision of approved, denied, or partially denied in some circumstances. The physician advisor/peer reviewer reviews the case in detail, potentially looking at the clinical criteria used for the denial and best practice.

External Peer ReviewBHM’s PRS Portal

Do you need an automated process to complete medical peer reviews? Do you need access to an independent review organization consisting of expert physicians in the healthcare field? BHM Healthcare Solutions is a full service healthcare consulting firm. One of our primary service lines is the Physician Peer Review facilitated by an automated PRS Portal.  The portal allows everything to be completed electronically, which provides standardization, time-saving data entry, the ability to track review status, and one place to maintain all of the data.

Health plans choose BHM for quality and timely medical review services conducted by board-certified and credentialed physicians for all lines of business and levels of review. In short, we use all available expertise to evaluate cases based on the most current evidence-based practices and national, state, or local regulatory guidelines.

Visit National Association of Independent Review Organizations for more information.