NMR Goes Beyond the Industry Standard for Review Services.
Account Management – Every client is assigned a primary Review Coordinator, a licensed nursing professional.
Review Coordinators – These nurses provide clinically-based account management and play an integral role in the processing of cases.
Medical Directors - While our nurses are the first line of contact, they are fully supported by in-house Medical Directors and a team of legal, administrative and account management professionals.
Management Philosophy is to provide comprehensive coverage with a clinical focus.
OUR CORE BUSINESS
The core business of NMR is providing Independent Medical Reviews for all types of Benefit Disputes and Quality of Care Issues.
- ADR/DRG/HCC Audits
- Clinical Guideline Peer Review
- Coding and Claims Validation
- Contract Reviews
- Criteria Analysis
- Disability Determinations
- Independent Dispute Resolution Process (IDR)
- Initial Decisions
- Long Term Care Benefit Trigger
- Medicare Exception and Reconsideration
- Member Hearings via Teleconference and Videoconference
- SIU Investigations
- 1st, 2nd and 3rd Level Appeals
HOW DO WE DIFFERENTIATE OUR PLATFORM?
NMR offers clients an end-to-end web-based case processing portal ~ UR Peer Port.
Hosted on a HIPAA compliant and SOC-2 certified Platform
NMR’s seamless, user-friendly portal can be tailored to meet your needs. We can do API via our UR Peer Port.
● Customized notifications and determinations
● Ability to interface with Healthcare Facilities
● Built-in case messaging portal
● Real Time Reporting on case processing statistics
● Environmentally conscientious Determination Delivery
Our technology is supported by real people. All accounts are assigned a primary Nurse Review Coordinator, combining technology and exceptional customer service.
NMR goes above and beyond to deliver top quality work. I really value their time and effort they put into each case and appreciate their friendly staff reaching out to me with any questions or concerns. All my cases have been returned in a timely manner, which is of great importance to me.
Our company’s experience with NMR has been nothing short of remarkable. NMR offers an extensive panel of Specialty Physicians, quick turn-around-times, and detailed, quality reports. NMR is our “go-to” for uncommon specialty reviews. They regularly meet or exceed deadlines, and with superior quality results. What’s also nice is, their portal is user friendly and can be personalized to meet business needs. Above all, NMR’s staff and support are exceptional! They are readily available and responsive to questions/comments in a timely fashion. NMR offers innovative solutions for associated business challenges, and they are very accommodating to unique processes. No ask is too big or too small! We truly value our business relationship with NMR and the exceptional service they provide!
It has been amazing working with the NMR team. They are fully transparent in how they can help meet State and Federal requirements and always maintains an open line of communication. Exceptional customer service and a pleasure to work with. Highly recommend!
National Medical Reviews is an Independent Internal and External Medical Review Organization with URAC Accreditation. National Medical Reviews is certified by the Departments of Health & Human Services, Treasury & Labor as an Independent Dispute Resolution Entity.
Since 1996 NMR has been serving:
ERISA Regulated Benefit Plans ♦ Federally Regulated Agencies ♦ HMO ♦ Health Care Facilities ♦ State Agencies ♦ Insurance Companies ♦ Medicaid ♦ Medicare ♦ PPO ♦ PBMs ♦ Self-funded Plans ♦ State Insurance Departments ♦ Third Party Administrators ♦ Utilization Management Companies ♦ Workers Compensation
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Our platform assists your operations with quick processing, data mining and specialized reporting.
Customizable to your workflows and needs, the portal makes submitting, tracking, and reporting on reviews of all types intuitive.