IRO Solutions for Government Programs
For Government
Government healthcare programs require meticulous management of medical claims and appeals, coupled with rigorous adherence to compliance standards and regulatory oversight.
Partnering with an Independent Review Organization (IRO) like BHM Healthcare Solutions ensures your agency receives unbiased, expert-driven medical necessity evaluations and appeals management. Our specialized IRO services help government entities achieve accurate claims adjudication, strengthen regulatory compliance, and reduce program risks through timely, defensible, and transparent decision-making.
Our Government Focused Solutions
BHM Healthcare Solutions is a trusted, accredited partner providing specialized services to government organizations.
As a NCQA and URAC accredited Independent Review Organization (IRO) and a proud member of the National Association of Independent Review Organizations (NAIRO), we consistently meet and exceed the highest industry standards. Our proven expertise and commitment to quality assurance align seamlessly with your organization’s expectations and objectives, ensuring exceptional results and unmatched reliability.
Independent Review Organization (IRO) Services
Ensure fair, accurate, and efficient claims reviews with our unbiased, independent assessments tailored to your self-insured health plans.
- Claims processing and adjudication reviews to determine medical necessity for both physical and behavioral health
- Identification and resolution of claims errors and discrepancies
- Unbiased, independent claim reviews to support fair and consistent decisions
Data Analytics and Reporting
Leverage advanced analytics and insightful reporting to drive informed decisions, enhance efficiency, and improve healthcare outcomes.
- Customized analytics and comprehensive reporting tailored to self-insured health plans
- Advanced data visualization and benchmarking tools
- Identification of key trends and actionable opportunities for cost and care improvement
Seamless integration with existing client data systems and software
Cost Containment and Reduction Strategies
Optimize your healthcare spending through strategic cost control measures and targeted initiatives designed specifically for self-insured organizations.
- Medical cost containment strategies, including utilization management review.
- Implementation of data-driven initiatives to reduce unnecessary healthcare expenditures
Consulting Services
Navigate complex regulatory environments confidently with expert guidance, compliance support, and proactive planning tailored to your organization’s unique needs.
- Expertise in ensuring compliance with ERISA, HIPAA, and related healthcare regulations
- Assistance with the development, updating, and maintenance of health plan documents
- Support during regulatory audits and compliance reviews
- Proactive regulatory guidance and continuous updates to maintain compliance
Utilization Management Software
PRS™ is an intuitive, cost-effective software solution that streamlines case management by consolidating data, minimizing errors, and optimizing workflow.
Why Choose BHM?
Who We Are
BHM is a trusted leader in healthcare solutions.
With over 20 years of industry experience, we’ve built a reputation for excellence by offering services and top shelf support that seamlessly integrate with your operational goals. Our expertise spans the full spectrum of healthcare delivery, ensuring that every solution is designed with your unique needs in mind.
Expertise
A trusted leader in addressing the complex needs of healthcare industry clients, we consistently meet rigorous quality standards, deliver rapid turnaround times, and provide deep medical specialty support.
Innovation
Our customized solutions are engineered to adapt to the evolution of the industry & empower our partners to stay ahead of emerging industry trends with proactive, forward-thinking strategies & technologies.
Outcomes
We champion operational efficiency, enhanced outcomes, and sustainable growth at every stage by delivering robust, measurable data informs strategic decisions & catalyzes continuous improvement.
Trust
Trust is the cornerstone of our processes.
With a focus on accountability and transparency, we consistently deliver results that serve our clients with integrity.
Client Solutions team
We are dedicated to your success and our client solutions team is your trusted partner, ready to deliver expert guidance and personalized solutions that empower your organization’s success.
This form provides a direct path to secure the information you need to take the next step in your journey.
