Using our services is easy with the NMR Client Portal. Register now to begin using our services today!
Services
Group Health
Requests can be submitted for medical necessity, experimental/investigational, fraud, waste & abuse, and quality of care. NMR will assign a physician to review the medical records of the patient whose claim is being disputed. After a review of the submitted medical records, including performing any requested teleconference(s) with associated treating provider(s), the reviewer will create a detailed report which summarizes their findings and addresses all requested questions specific to the claim. Findings are supported by recent and relevant references from policy/plan language, peer literature, publications, or national criteria. Each report receives a thorough quality assurance check performed by a nurse before being returned to the client. As a result of NMR's best in class policies, procedures and workflows virtually any requested turn-around time can be accommodated.
Services Offered:- Initial Peer Reviews
- Appeal Peer Reviews
- PPACA Appeal Reviews
- State Level External Review
- Cost Containment & Payment Integrity Reviews
- Fraud, Waste and Abuse Reviews
- Policy & Plan Ratification Reviews
- Quality of Care Reviews
Workers' Compensation
Workers' Compensation (WC), which covers medical and rehabilitation costs and lost wages for employees injured on the job, is required by law in all 50 states. Each state is self regulated and the following requirements need to be verified in order to complete a WC referral:
- Same State Physician Specialty Requirements
- Same State Physician Licensing Requirements
- Specific criteria guideline mandated
Disability
Requests can be submitted for both short (12 weeks to 1 year) and long (over 1 year) term disability, permanent/total disability, and FMLA related claims. NMR will assign a physician to review the medical records of the patient whose claim is being disputed. After a review of the submitted medical records, including performing any requested teleconference(s) with associated treating provider(s), the reviewer will create a detailed report which summarizes their findings and addresses all requested questions specific to the claim. Each report receives a thorough quality assurance check before being returned to the client in the requested timeframe.
Services Offered:- Short Term Disability (STD) Peer Reviews
- Long Term Disability (LTD) Peer Reviews
- Permanent/Total Disability (PTD) Peer Reviews
- FMLA Clarifications (Self & Family)
- Panel Peer Review
Independent Medical Evaluation
Requests can be scheduled for workers compensation, disability, or liability claims. NMR will assign a physician in the specified geographical location in order to evaluate the patient whose claim is being disputed. After the examination, including a review of any associated medical records, the examiner will create a detailed report which summarizes their findings and addresses all requested questions specific to the claim. Each report receives a thorough quality assurance check before being returned to the client in the requested timeframe.
Services Offered:- Independent Medical Examinations
- Functional Capacity Evaluations
- Neuropsychological Testing
- Fit For Duty (Physical & Mental)
- FMLA (Second & Third Opinions)
Liability
Requests can be submitted for causality, medical necessity, treatment frequency, and cost/charge appropriateness. NMR will assign a physician to review the medical records of the patient whose claim is being disputed. After a review of the submitted medical records, including performing any requested teleconference(s) with associated treating provider(s), the reviewer will create a detailed report which summarizes their findings and addresses all requested questions specific to the claim. Each report receives a thorough quality assurance check before being returned to the client in the requested timeframe.
Services Offered:- General Liability Peer Review
- Employer/Employee Liability Peer Review
- Auto Liability Peer Review
Referral Request Submission and Technology.
We offer our Client Portal to our clients who need two-way communication throughout the referral process. The Client Portal includes live status updates, document additions, messaging, and retrieval of current and historical Reports.
We also have the capabilities for other methods to receive your Referral Requests for bulk entry such as FTP and Web Services.
NMR is accredited as a Comprehensive Independent Review Organization by URAC.
URAC, an independent, nonprofit organization, promotes health care quality through its accreditation, education and measurement 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 provides a symbol of excellence for organizations to validate their commitment to quality and accountability.
Network Medical Review Company, Ltd. receives a SOC 2® Type 2 report annually.
HITRUST CSF Certified Status indicates that NMR meets key healthcare regulations and requirements for protecting and securing sensitive private healthcare information.
Location
Network Medical Review Co. Ltd. 4960 East State Street Rockford, IL 61108 P: (815) 964-6334 F: (815) 964-1162