URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation and certification programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC strives to ensure that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information, visit www.urac.org.
MET Healthcare Solutions provides a cost effective quality service that meets our client’s specific needs. We offer 24 hour/7 day a week phone access and an online secure client portal for case submission.
Group Health Plans
MET’s Group Health division focuses on reducing the cost of claims through the application of nationally recognized clinical and evidence based guidelines. Our experience with Group Health Plans include state external reviews, internal appeals, behavioral health reviews, medical/surgical reviews, administrative reviews and dental reviews. MET offers a courtesy review for administrators of group health plans to prove our quality of medical review decisions.
MET offers a wide range of products and services to the Workers’ Compensation arena by helping clients manage risks and reduce costs by utilizing Independent Medical Evaluations and Independent Medical Reviews. Our workers’ compensation services are based on state and federal workers’ compensation laws and regulations. MET offers a courtesy review for administrators of workers compensation plans to prove our quality of medical review decisions.
Hospitals can benefit from MET’s IRO services for their most difficult and complex sentinel events. The peer review process a hospital performs is oftentimes considered a conflict of interest and can lead to unfair determinations against a healthcare providers for competitive internal reasons. Organizations that have decided to try MET’s IRO services have found them to be highly effective in rendering effective, objective, unbiased medical decisions using the same or similar specialty on evidence based guidelines and medical facts. MET offers a courtesy review for administrators of hospitals to prove our quality of medical review decisions.
IRO Services for Corporate Integrity Agreements (CIA)
MET provides claims review services and medical necessity determinations for Healthcare Providers who have entered into a Corporate Integrity Agreement (CIA) with the OIG which requires an Independent Review Organization (IRO). Claims review services are performed by experienced staff who maintain a nationally recognized coding certification with expertise in Medicare and individual State Medicaid program requirements. If the CIA requires medical necessity determinations, these are performed by licensed healthcare providers, with the same specialty possessing current hands on treatment experience. MET compiles the reports required under the CIA for submission with the Providers annual report to the OIG.
MET’s auto and casualty liability division will assist clients in the medical aspect of the claim. All programs offered are based on the state/jurisdictional area involved with each claim. MET offers a courtesy review for administrators of Auto/Casualty liability plans to prove our quality of medical review decisions.
State Department of Insurances
MET has healthcare providers in each state trained and qualified to perform IME’s at the State Department of Insurance levels.
For more information on how MET Healthcare Solutions can be of benefit to you and your organization, please click on the contact us page, email or call 1-800-845-8982.