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Medical necessity is a medical claims determination which encompasses outcomes which are justified as reasonable, necessary, and/or appropriate based on evidence-based clinical standards of care.
BHM Healthcare Solutions, a healthcare consulting firm first introduced the PRS portal for providing physician peer reviews in August 2011. Since then, BHMs IT Department has made continual improvements to the PRS Portal to increase automation, efficiency, and responsiveness.
NAIRO’s External Review Regulations The National Association of Independent Review Organizations (NAIRO) was formed in 20012 by a group of URAC-accredited Independent Review Organizations (IROs).
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.
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