Payer Best Practices, Data quality

BHM Healthcare Solutions

Pursuing excellence when serving our clients and helping deliver high-quality and cost-effective care since 2002.

Our Purpose and Passion

To meet or exceed client requested
turnaround times and
deliver accurate results. 

Utilization Management

What Sets Us Apart?

Trust is the cornerstone of our processes. With a focus on accountability and transparency, we consistently deliver results that align with regulatory standards, support better patient outcomes and serve our clients with integrity.

Network Coverage

Board certified reviewer network represents a vast array of specialties and sub-specialties.

Audit
Process

Continuous self-auditing of reviewer performance assures we meet or exceed our client's expectations.

TAT
Commitment

BHM’s turnaround time (TAT) commitment raises expectations for delivering accurate results.

IRO
Coordinators

IRO Coordinators oversee reviewers adding the human touch to performance metrics.

Proven History of Quality

BHM earns the most respected credentials needed for delivering the best client results.

Payers and providers know the URAC, NCQA, and HITRUST brands and their high-bar quality requirements. Our credentials fit hand in glove with your organization’s expectations.

independent review organization
NCQA Accreditation Experts, NCQA Accreditation Consulting
trust
URAC Accreditation Consulting

At BHM Healthcare Solutions, every claim is reviewed by board certified medical professionals who understand the nuances of healthcare decisions. Our process ensures accuracy and fairness.

Our team is dedicated to elevating your organization to new levels of success.



Questions? Contact us!

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“An independent review organization (IRO) acts as a third-party medical review resource which provides objective, unbiased medical determinations that support effective decision making, based only on medical evidence. IROs deliver conflict-free decisions that help clinical [patient care] and claims management professionals better allocate healthcare resources.”

– National Association of IROs

Good question. Whether your organization is a health system or insurance company, IROs often build value by

  • Providing access to networks of doctors specializing in unique and complex care.
  • Lowering the cost of maintaining and recruiting in-house medical subspecialties and behavioral health experts for reviews.
  • Building more efficient, independent support for applying medical necessity criteria
Utilization review contains three types of assessments: prospective, concurrent, and retrospective. BHM expertly handles all aspects, including appeals.
Utilization Management