Commitment to
  • Connect with Doctors
  • Clear Communications
  • Completion Deadlines

Health plans choose BHM for quality and timely medical review services conducted by board-certified and credentialed physicians for all lines of business and levels of review.

In short, we use all available expertise to evaluate cases based on the most current evidence-based practices and national, state, or local regulatory guidelines.

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peer review management, Clinical Review, Independent review organization
Commitment

Connect
Doctors To Doctors

When doctors connect, relationships grow and appeals happen less often.

+ 0 %
Connection Rate for
Peer-to-Peer Calls
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Get Clear Communications with Members and Patients

Clear Communications with patients and members can lead to higher satisfaction and improved outcomes.

4-6th

NCQA-compliant member statements meeting the required reading levels developed by experienced clinicians clearly explains each determination.
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Utilization Management

Push Notifications
Keep You Connected

Complex reviews, by their very nature and financial impact, raise the bar for hitting deadlines.
0 %

Each and every step of the review process generates a notification keeping you informed of progress.

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Accuracy Check

17-point data entry accuracy check BEFORE going to reviewer.

Validating Completeness

Validating completeness of every request and synthesizing clinical notes BEFORE reviewer assignment means every review is based on accurate and complete records.

Peer-to-Peer Calls

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.

Turnaround Times

We meet our client times with 99.4% accuracy.

Build your peace of mind

You remain in compliance with your accreditation standards and regulatory requirements.

Clincial Audit

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.

Accreditations

NCQA (UM), URAC (IRO), and HITRUST

More peace 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

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

Credentials Trusted throughout Healthcare

BHM Healthcare Solutions began in 2002 bringing insights to hospitals and payers though efficiency consulting and behavioral health expertise and growing into the powerfully nimble resource for your organization. 

20+

years of serving the  healthcare industry

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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.

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Physician Peer Reviews, peer review partner, physician peer to peer review

Utilization Peer Review