Independent Review Organization
BHM, serving as an outsider to your organization, offers expertise that is independent of the health plan, the hospital, and the patient.
In short, our sole purpose is to use all available expertise to evaluate cases based on the most current evidence-based practices and national, state, or local regulatory guidelines.
What Is An Independent Review Organization (IRO)?
“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
How Can My Organization Benefit From an IRO?
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
Why Choose BHM Healthcare As My IRO?
Glad you asked, because BHM stands apart from most IROs in a number of ways.
Below are just a few. Hover over each and see how they benefit organizations, like yours:
17-point data entry accuracy check BEFORE going to reviewer.
Validating completeness of every request and synthesizing clinical notes BEFORE reviewer assignment means every review is based on accurate and complete records.
Significantly beat industry connection rates.
85% connection rate
Reviewers speaking with providers allows providers the opportunity to fill in the details, nuances, and thinking behind their notes lead to improved provider relations.
We meet our client times with 99.4% accuracy
Build your piece of mind
You remain in compliance with your accreditation standards and regulatory requirements.
Post-review clinical audit BEFORE going to client.
Highest quality determination
BHM’s clinical services team reviews each determination ensuring accuracy, completeness, and attention to detail; delivering the highest quality determination report.
NCQA (UM), URAC (IRO), and HITRUST
More piece of mind
BHM meets industry quality standards. NCQA-Accredited programs are eligible for automatic credit when they work with another NCQA-Accredited organizations.
Complex cases, like behavioral health, are not complex to BHM.
The BHM Difference
Imagine your complex cases processed as easily and as accurately as your most typical requests.
That’s the BHM difference
Building Trust and Confidence
This level of service builds trust and confidence that decisions are both rational and equitable. Conducting diplomatic, effective peer-to-peer consults with the attending physician as needed builds stronger provider relationships for your health plan while ensuring all relevant case details are considered when making an appropriate determination.
Utilization management (UM) decisions, made by BHM Healthcare Solutions (BHM) designated reviewers, use nationally recognized criteria and are based only on appropriateness of care and services, including the existence of coverage. BHM does not compensate anyone for denying coverage or service, nor does it use financial incentives to encourage denials or the under-utilization of any needed medical service.