Services
RRS has a credentialed panel of peer-review doctors from all states and specialties to determine the medical necessity and the appropriateness of treatment and services- utilizing state and official guidelines and current medical literature.
We use the best quality assurance process, professional clinical resources, and overall best practices and meet the strictest turn-around time requirements with our tailored reports.
Our Peer Review Service Capabilities
Disability
Disability plans are serviced through independent peer review, which provides clinical expertise to support plan decisions.
We offer a full range of Disability review services, including;
- Short-term disability (STD)
- Long-term disability (LTD)
- Disability pension
- Nurse Disability Advisory Review
- Salary continuation market
- Accidental Death and Dismemberment
Workers' Compensation
Employing state guidelines, official disability guidelines, and or current medical literature, peer review reports are provided to meet the strictest of turn-around time requirements and standards of quality.
Our Workers’ Compensation service capabilities include;
- Medical Necessity
- Initial Review and Appeals
- Causation Reviews / Early Compensability Assessment (ECA)
Group Health
Utilizing current medical literature, plan documents, or other recognized guidelines to determine medical necessity and appropriateness of medical treatment and services in the Utilization Review (UR) and Utilization Management (UM) setting.
We provide peer review services for many Group Health claim types including:
- Experimental/Investigational
- State External Review, and SIU/Fraud Waste and Abuse
- Medical Necessity
- Initial Review and Appeals
- Federal External Review (PPACA)
- Quality of Care reviews
- Fraud and Abuse reviews
- Genetics
- Medical Policy
- Research & Development
- Pre-existing Conditions
- Panel Reviews
- ERISA Appeals
Pharmacy
Independent peer review helps you to provide the claimant with a full and fair review that is impartial and promotes consistency and fairness.
We are equipped to provide a range of Pharmacy peer review types including;
- Medical Necessity
- Initial Review and Appeals
- Appropriateness of Prescribing Patterns
- Physician Validates, Modifies, or Supplements PBM Pharmacist Review
- Fraud and Abuse
- Litigation and Forensic Support
Liability
Our Physician Network is able to determine the medical necessity and the appropriateness for Liability reviews.
Our Liability services include;
- Personal Injury
- Auto Liability
Accidental Death and Dismemberment
Reliable Review Services (RRS) offers comprehensive medical reviews to evaluate the autopsy record, ambulance records, hospital/emergency room records, and witness statements in order for a plan to make an appropriate determination.
Accidental death insurance is a special type of policy that provides payments when a person dies as the result of an accident. It is usually combined with a dismemberment policy and will provide benefits when a person loses certain parts of his/her body or the ability to use those body parts because of an accident.