CMS provides recommendations in regard to the medical necessity of services utilizing evidence-based criteria. Our clinicians have expertise in identifying appropriate care options early in the review process without compromising quality of care. The results are satisfied insured’s and employer group cost savings.
CMS clinicians provide consultation on the following:
- Concurrent reviews.
- Retrospective reviews.
- Durable medical equipment rental or purchases.
- Ambulance services.
- Outpatient treatments.
- Potential cosmetic services.
- Experimental or Investigational procedures.
- Negotiated costs with out-of-network providers.
- Reinsurance Reviews for timely and accurate calculations of future projected health care costs as related to the specific deductible.