Our process at NMR ensures each claim referral and the related medical record documents are reviewed fully for completeness and precision prior to the assignment of the claim to be reviewed by one of our network specialists.

Once a claim is assigned, the specialist will review all claim-specific details and make outbound telephonic outreach attempts (Peer-to-Peer) to the claimant’s attending provider(s) in an attempt to discuss the individual’s claim for benefits/services and gather any objective and pertinent clinical information that may not be available within the provided medical records. Using all of the information available during the peer review process, the specialist will then render an impartial, evidence-based assessment in the form of a paper-based report to be returned to NMR and every report will undergo a Quality Assurance (QA) audit performed by the appropriate clinical team. These QA audits are intended to ensure all clinical and clerical deficiencies are identified and addressed prior to the submission of the report(s) to our client.

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