Transforming Healthcare Payer Partnerships
for Healthcare Payers
At BHM, we understand that in today’s dynamic healthcare environment, payers require more than just traditional service providers—they need strategic partners who can drive innovation, optimize outcomes, and deliver measurable value.
Our proven track record in creating customized healthcare solutions means that you can focus on what matters most: improving member satisfaction and lowering overall costs.
Our Payer-Focused Solutions
BHM Healthcare Solutions is committed to delivering personalized, high-quality services tailored to healthcare payers.
Our seasoned experts partner closely with clients to create customized solutions that drive efficiency, enhance compliance, and elevate outcomes. Learn more about our comprehensive suite of payer-focused services to discover how BHM can support your organization’s unique objectives.
Utilization Management & Appeals Review
Delivering high-quality, accurate, and on-time determinations with minimal impact on your frontline staff’s time solidifies BHM as your vendor of choice for full spectrum of case review services.
Licensed in all 50 states, our extensive network of reviewers give you the edge.
Utilization Management (UM)
- Behavioral Health Initial Reviews
- Physical Health Initial Reviews
- Peer-to-Peer (P2P) Reconsideration Reviews
- Prior Authorizations
- Reconsiderations
Appeals Review
- All 1st Level Appeals
- All 2nd Level Appeals
- All 3rd Level Appeals
Additional Reviews
- Specialist Reviews
- Complex Reviews
- Nurse Reviews
- Workers Compensation Reviews
- Pharmacy Reviews
- Trial Expertise & Expert Witness
Medical Director Services
On-demand Medical Director services offer expert oversight and staffing solutions to maintain compliance and ensure operational continuity.
Tap into BHM’s vast network of healthcare experts when you need additional capacity.
Consulting
Backed by decades of proven success in the healthcare industry, BHM delivers unparalleled consulting expertise.
- Accreditation/Reaccreditation Consulting:
Enjoy a smooth accreditation journey with our experienced team’s assistance. [explore] - Business Intelligence Consulting:
We turn complex data into clear insights, empowering real-time decision-making & strategic growth. [explore] - Performance Improvement Consulting:
Leverage the expertise of our experienced team to help achieve operational efficiency. [explore]
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.
How can we help you today?
Frequently Asked Questions
How do BHM’s healthcare payer solutions reduce administrative burden?
Our healthcare payer solutions include outsourced utilization management and peer review services. By leveraging our licensed experts, payers reduce internal workload, cut operational costs, and maintain compliant, evidence-based decisions.
Are BHM’s healthcare payer solutions available nationwide?
Yes. Our clinical reviewers are licensed in all 50 states, ensuring that health plans and insurers receive seamless coverage and compliance support across every market.
What turnaround times can payers expect from BHM’s solutions?
Most utilization reviews are completed within 24 hours, with rapid requests handled even faster. Our streamlined processes help payers improve efficiency and meet critical deadlines.
How do BHM’s payer solutions ensure compliance with CMS and NCQA standards?
Our team specializes in payer accreditation and regulatory frameworks. We continuously align our processes with CMS, NCQA, URAC, and state-specific requirements, helping payers stay audit-ready and compliant.
What makes BHM’s Medical Director Services different from traditional staffing models?
Unlike full-time staffing, our on-demand Medical Director Services provide board-certified physicians who integrate directly into payer workflows. This gives health plans flexibility, expertise, and cost savings without the overhead of permanent hires.
Do BHM’s healthcare payer solutions include technology to improve operations?
Yes. Our proprietary PRS™ software streamlines payer operations by automating workflows, compliance tracking, and reporting. It helps payers improve utilization management and appeals processing.
Can BHM’s payer solutions scale for both large national plans and smaller regional payers?
Absolutely. We partner with national insurers, regional health plans, and Medicaid/Medicare-focused payers. Our solutions are designed to scale based on your size, market, and operational needs.
What measurable outcomes do payers see with BHM’s solutions?
Clients leveraging our healthcare payer solutions report reduced appeal overturns, lower administrative costs, faster turnaround times, and improved compliance audit outcomes, all of which strengthen provider networks and member satisfaction.