- 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.
When doctors connect, relationships grow and appeals happen less often.
Get Clear Communications with Members and Patients
Clear Communications with patients and members can lead to higher satisfaction and improved outcomes.
Keep You Connected
Each and every step of the review process generates a notification keeping you informed of progress.
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.