Solutions

Customized and Actionable


We work as a trusted partner to identify and develop the optimal review program for each client, whether prior authorization, concurrent and/or post-payment reviews. Applying evidence-based practice, clinical expertise and established policies, our reviews safeguard against unnecessary, ineffective and inappropriate use of services.

  • Prospective
  • Concurrent
  • Retrospective
  • Education

Outcomes

30+

30+ years’ experience

We apply more than three decades of institutional experience to manage utilization and deter overutilization of valuable health care resources.

0

0 overturned decisions

No appealed adverse decisions have been overturned by an Administrative Law Judge since 2015.

738K

738,000 reviews on time

Our experts completed 738,800 review for prior authorization of therapy services for the state of North Carolina over a five-year period with 99.9 percent completed on time.

Outcomes

30+

30+ years’ experience


We apply more than three decades of institutional experience to manage utilization and deter overutilization of valuable health care resources.

0

0 overturned decisions


No appealed adverse decisions have been overturned by an Administrative Law Judge since 2015.

738K

738,000 reviews on time


Our experts completed 738,800 review for prior authorization of therapy services for the state of North Carolina over a five-year period with 99.9 percent completed on time.


Customers

Decades of experience


Our broad experience, knowledge base and agility allow us to adapt our work to best meet the needs of State agencies and others across the spectrum of health care settings.