Independent Medical Reviews
MET is an Independent Review Organization (IRO) accredited through URAC, a non-profit organization that helps promote health care quality through standards that validate organizations are committed to a fair and impartial medical review process that benefit both patient and physician appeals.
URAC accredited IROs undergo a thorough screening process to ensure health plans and consumers receive a comprehensive review and objective appeal decision.
We provide nationwide Independent Medical Review services for state insurance departments, group health plans, worker’s compensation, utilization review companies, hospitals, employers, benefit administrators, attorneys, and casualty insurers.
Our peer reviews are free from conflict and performed by highly-trained, unbiased legal professionals, board-certified physicians, and qualified healthcare providers, in compliance with specific state, federal, and URAC mandates.
Utilizing an evidence-based decision process, our peer reviews reduce both administrative costs and liability while improving member satisfaction.
Independent Medical Review and Appeal Services:
First Level Review
We review whether an initial request for a medical service or treatment is medically necessary or experimental/investigational. As a URAC-accredited IRO, we maintain higher industry standards for validating your review through our team of medical professionals resulting in significant cost savings and enhanced member satisfaction.
Internal Medical Appeal (Second Level Review)
When a first level review is denied, one may wonder if the denial was rushed or biased. Outsourcing your second level review to MET's URAC-accredited IRO team of physicians, who are active in the specialties being discussed, will provide you with an unbiased second level review, enhancing member satisfaction.
External Review
When the internal medical appeal process has been exhausted, an external review can be requested to determine whether the denied medical treatment is medically necessary or experimental/investigational. MET's URAC-accredited IRO team provides unbiased external reviews using specialty matched physicians with current hands on experience in the requested treatment.
Contractual (health plan) Appeal
Our team of contractual experts conduct reviews for consumers and plans regarding the rescission of benefits, benefit interpretations, reimbursement issues, and other administrative/legal concerns to determine if a plan was applied appropriately. Consult with our contractual team to determine the next steps in your health plan appeal.
Legal Review
When your legal team needs an expert medical opinion, we have the answer. Our diverse network of physicians, doctors, and certified coders provide the evidence necessary to strengthen your position. Contact us now to start building your defensible case.
Second Opinion Review
When the first opinion isn't quite powerful enough, our second opinion review team of board-certified physicians will assemble a defensible medical opinion for validating medical necessity and appropriateness of proposed treatments or services.
Quality of Care Review
Hospitals, long-term care centers, and healthcare providers work hard to promote the effective, efficient, and economical delivery of health care services. Using our team of medical professionals, we review whether the quality of care meets professionally-recognized standards.
Compensability/Early Assessment
We help reduce the amount spent on non-compensable medical expenses. Our team of medical experts defines the appropriate limits of the claim through comprehensive evaluation of the medical evidence. To begin the process of saving money, call us today!
Long Term Disability Reviews
Outsourcing your long-term disability reviews to MET reduces the likelihood of future appeals. Backed by evidence-based medicine, our board-certified physicians provide objective medical opinions on your claimant’s medical status and functional abilities.
Pharmaceutical Review
Our pharmaceutical review team conducts comprehensive prospective, concurrent, and/or retrospective reviews to verify medical necessity and efficacy thereby minimizing over-utilization and improving health outcomes.
Radiology Review
Capable of handling large, memory-intensive image uploads, our state-of-the-art secure platform allows for quick and efficient radiological interpretations by our team of board-certified radiologists.
Medical Director Consultation
Our medical director consultants provide reviews of current policies, verify the credibility of your peer review program, design medical protocols, assist with program development, and perform health audits. To learn more about our medical director consultants, call us today.