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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

 

 

Contact

 

An Accredited National Leader

 

MES Peer Review Services (PRS) is a URAC accredited Independent Review Organization - Comprehensive (IRO-C), and MES is accredited for CORE Organizational Quality, Workers' Compensation, and Utilization Management. 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

MES Solutions and MES Peer Review Services provide the claims community access to physicians with expertise in conducting Independent Medical Examinations, Record Reviews, and Peer Reviews. Clients include insurers, third-party administrators, self-insureds, government agencies, and attorneys. Markets served include auto, disability, liability, workers' compensation, and group health. MES Medicare Solutions provides payers the analytical expertise to comply with Medicare secondary payer regulations.

Learn more

ADDRESS

MES Solutions, Inc.
150 Presidential Way
Suite 110
Woburn, MA 01801

PHONE

781-933-1782

FAX

781-933-5099

EMAIL

info@messolutions.com