Commitment to

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.

peer review management, Clinical Review
Commitment

Connect
Doctors To Doctors

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

85%

Connection Rate for
Peer-to-Peer Calls

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.
Utilization Management

Push Notifications
Keep You Connected

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

100%

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

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

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.

Physician Peer Reviews, physician peer to peer review

Utilization Peer Review