Physicians Review Organization is accredited both as an internal and external review organization through URAC—an independent, nonprofit organization which establishes meaningful quality measures for the entire health care industry. 

Achieving URAC accreditation means we are committed to a fair and impartial medical peer review process that benefits both patients and physicians with grievances. URAC accreditation is designed to ensure that review organizations are free from conflicts of interest, establish qualifications for physicians performing independent medical peer review, address medical necessity and experimental treatment issues, and have reasonable time periods for standard and expedited peer reviews, as well as appeals processes.

We comply with federal requirements and those of all states in which we conduct business. Our experienced staff, board of directors and advisory committee ensure exceptional service.


Advantages

Each of our reviews are performed by board-certified physicians. And with more than 250 licensed physicians serving as reviewers in 65 different specialties, you can rest assured that each case review is accurate and unbiased. 

Effective and meaningful physician peer reveiw focuses on improving physician performance rather than just reviewing errors. Peer review can help physicians improve outcomes, identify areas of potential, and help providers maintain the highest of standards. 

physicians

Our reviewers are all qualified, practicing physicians who are experts in their fields. Because they are currently active in medical society, they approach each case they review with the most current, relevant medical knowledge.

We train each evaluator in the unique practical and cost-effective solutions we developed for evaluation and improvement of patient care. Our Board of Directors and Quality Improvement Committee ensure the reviewers have all the tools needed to help ensure patients have the best care that providers can give. 

services

Physicians Review Organization has more than 30 years of experience and performs reviews based upon the most current medical knowledge. We can be trusted to offer the most accurate, unbiased, efficient, and cost-effective results in the industry.

Quality of Care Review

  • Evaluate the adequacy of documentation
  • Measure compliance against current care standards
  • Identify areas of actual or potential quality concerns
  • Provide recommendations for quality improvement, if indicated

Utilization of Service Review

  • Evaluate medical necessity of service with consideration of:
  • Severity of illness and intensity of service factors
  • Rationale for alternative care settings

Individual Provider Review

  • Evaluate adequacy of documentation
  • Address areas of concern or questions identified by client
  • Measure compliance against current care standards
  • Provide recommendations for quality improvement and ongoing monitoring, if indicated

Other Services

  • Recovery Audit Contract Appeal
  • Adverse Benefit Determinations