Ready & Responsive
NMR can be your source to fulfill your independent internal and external review needs.
National Medical Reviews, Inc.’s (NMR) organizational mission is to provide for healthcare transparency between the payer and consumer by delivering high quality, evidence-based, independent specialty matched medical review services that are cost effective, expedient and objective.
We have been servicing the healthcare industry since 1996.
NMR’s clients include health insurers, managed care organizations, health maintenance organizations, preferred provider organizations, third party administrators, multi-employer and self-funded plans, federally regulated entities, medical and utilization management firms, workers’ compensation carriers, state labor and industry departments, departments of public health, Department of Justice, hospitals, law firms and other medical review companies.
Geographically Diverse Peer Review Panel
NMR maintains a geographically diverse Peer Reviewer Panel (PRP) that is strategically located throughout the United States. NMR performs in-house credentialing in compliance with URAC standards, which includes primary source verification of licensure and board certifications.
The PRP is comprised of over 500 individual providers, representing over 700 board certifications, specialties and state licenses.
Our in-house Credentialing Department maintains an active recruitment process, allowing for an ever-expanding panel, to ensure a prompt response to clients’ needs.
Web Portal Case Processing
Assign, track, and receive claim reviews in real-time via NMR’s secure HIPAA compliant case processing system, UR-Peer Port.
NMR’s UR-Peer Port Case Processing System allows both Clients and Reviewers to easily interface with NMR in the processing of claim reviews. This solution includes value added features such as:
• Instant Message Interface
• Supervisor Oversight
• Auto Fill Feature
• Unlimited File Size Uploads
• Real-time Case Status Updates
• Aggregate Reporting Features
NMR goes beyond the industry standard for review services. Our account management philosophy is to provide comprehensive coverage with a clinical focus.
Each client is assigned a primary nurse Review Coordinator (RC) who provides clinically based account management and plays an integral role in the processing of cases and confirmation of regulatory compliance.
While our nurses are the first line of contact, they are fully supported by in-house medical directors, administrative and account management professionals. NMR’s Chief Medical Director provides oversight for the review process and is accessible to clients
Evidence Based Determinations
NMR considers both the plan documents and regulatory requirements when determining whether the treatment under review is considered a covered benefit.
In addition, our specialists use standards of care as supported by peer reviewed literature to support their clinical judgment.
NMR’s Quality Management Program ensures that our clients receive the highest quality independent reviews from our peer reviewers in a timely manner.
RC oversight is not complete until every Peer Reviewer report is checked for compliance and accuracy. NMR employs a systematic procedure for continuously monitoring and evaluating our internal processes.
Audits are performed to monitor for quality in timeliness, medical management, credentialing, and medical director activities.
National Medical Reviews, Inc. has full accreditation from URAC as an Independent Review Organization.
A straightforward pricing structure allows our customers to determine total costs up front for each referral. Customers pay the same fee for access to all specialties and subspecialties represented on NMR’s Peer Review Panel.
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