User Name Password  
Home Amalgamated Life

AliCare | Independent Physician Review

AliCare Medical Management provides Independent Physician Review Services for hospitals, managed care organizations and health care systems nationwide, which are accredited pursuant to URAC’s Independent Review Standards.

AliCare Medical Management supports the full array of state and federal regulatory mandated appeals, both on a standard and expedited basis. Similarly, AliCare Medical Management Independent reviews comply with URAC and NCQA criteria.

Independent Physician Review services include the following:

  • First level pre-certification/concurrent review
  • First and second level appeals
  • Expedited appeals
  • Retrospective reviews
  • Investigational/experimental assessments
  • Medical claims reviews including coding and DRG
  • Physician consultation
  • Quality of care assessments
  • Disability and Accidental Death and Dismemberment (AD&D) reviews
  • Pharmacy Reviews
  • Meets all Patient Protection and Affordable Care Act (PPACA) requirements

Click here for more details