Need help now? Talk to an expert
(888) 831-1171
email: accounts@medreviewexperts.com
Need help now? Talk to an expert
(888) 831-1171
email: accounts@medreviewexperts.com
Health plans, providers, and TPAs rely on MRE, Medical Review Experts, for utilization management reviews that deliver consistent accuracy, fast turnaround, and full regulatory alignment — all backed by our proprietary 17-Point Quality Validation process.
Board-certified physician reviewers assigned to every case.
92% of reviews delivered in 48 hours or less.
URAC Accredited. NCQA, CMS, OIG, HiTrust aligned.
Secure, HIPAA-compliant platform with full case visibility.
Dedicated account teams. Proactive communication.
Proprietary 17-Point Validation Process on every case.
Utilization Review:
Prospective | Concurrent | Retrospective | Medical Necessity Determinations
Independent Peer Review:
Board-certified specialty matching. Clinical appropriateness assessments.
Appeals & Denials Management:
Level I, II, III appeal support. Complex external appeals.
Medical Director Support:
Overflow review capacity. Policy consultation. Clinical guidelines refinement.
All services backed by our proprietary 17-Point Quality Validation Process and secure technology platform.
Speak with an Expert
888-831-1171
20+ Years of experience
Q1: What is a utilization management review service and how does it benefit health insurance payers?
A: A utilization management review service (also called utilization review or UM/UR review) is a formal assessment of medical necessity, appropriateness, and efficiency of healthcare services, performed at prospective, concurrent, or retrospective stages. For payers, this ensures better cost control, reduces denials, improves regulatory compliance, and enhances consistency in appeals outcomes.
Q2: How quickly can Med Review Experts deliver utilization management reviews?
A: We are committed to speed and reliability—our licensed clinical reviewers deliver an average 24-hour turnaround on utilization management reviews (subject to receipt of all required documentation). This rapid timeline helps payers minimize delays in claims adjudication, reduce appeals backlog, and improve provider satisfaction.
Q3: How much cost savings can a payer expect when outsourcing utilization review and appeals?
A: Our clients often realize up to 30% in cost savings on appeals and denied claims. By optimizing workflows, applying evidence-based criteria, and reducing internal overhead, outsourcing utilization review can yield meaningful reductions in handling costs and appeal volumes.
Q4: How does Med Review Experts ensure compliance with CMS, NCQA, URAC, and state regulations in utilization management?
A: Compliance is foundational to our approach. We maintain licensed reviewers in every state, operate under up-to-date policy frameworks aligned with CMS, NCQA, URAC, and applicable state statutes, and continuously audit our processes. We also embed regulatory checks in our technology platforms and consulting services to help payers stay current with shifting utilization management rules.
