Peer Review Services

Standard Benefits

Meet demanding TAT times

Real-time case tracking

Advanced duration and management reporting

Secure web-based scheduling

Peer-to-peer contact

RN oversight and QA

Full-service support

Target Areas

Coding

Federal/External State Reviews

Fraud and Abuse

Grievances and Appeals

Pharmacy Benefit Management

Quality of Care/Compliance

Utilization Management

An Accredited National Leader

MES Peer Review Services (PRS) is a URAC accredited Independent Review Organization - Comprehensive (IRO-C) and MES Solutions is accredited for Independent Medical Examinations. We received HITRUST CSF certification demonstrating our technology meets key healthcare regulations and requirements for protecting and securing sensitive protected healthcare information. These third-party audits ensure that healthcare controls, finance, and IT processes meet industry standards and translate into superior quality services.

Peer Reviews are paper-based evaluations prepared by credentialed, independent physicians to establish an informed expert opinion about the appropriateness of care, medical necessity, experimental/investigational, and related issues. With access to a broad nationwide network of board-certified physicians and licensed allied professionals from all major specialties and sub-specialties, we are able to provide our clients the appropriate expertise for a range of review types: prospective, medical-legal, appeal, and peer-to-peer reviews. Final reports are tailored to meet state-specific content and turnaround time requirements, with reports available on the MES or respective client portal.

Markets Served

PRS is a division of MES that provides evidence or standards-based independent medical peer review for national insurance carriers, self-insured entities, third-party administrators, and government agencies across the country. Whether facilitating peer reviews in group health, workers’ comp, disability, pharmacy, or fraud and abuse, we work with clients to understand their specific client process requirements. Our experienced operations staff and flexible portal technology facilitate compliance with mandated state or jurisdictional regulations, cybersecurity protocols, and the highest level of standards for quality assurance.

• Group Health, Commercial, Medicare, and Medicaid
• Workers’ Compensation
• Disability
• Pharmacy Benefit Managers
• Special Investigation Units (SIUs)
• Hospital Quality and Compliance