Specialty-Matched Internal and External Appeals

For over 25 years, leading organizations have been turning to AllMed to process their member and provider specialty-matched appeals for medical, behavioral health, pharmacy benefits and DME.

Every health plan, MCO/CCO, TPA and PBM has its unique protocols when it comes to managing this process. Some use internal physician advisors and Medical Directors for managing first and second-level appeals internally. However, with more pressure to reduce costs, improve quality, and avoid conflicts of interest, they are increasingly turning to AllMed to manage these clinical decision-making processes. Additionally, regulatory changes have provided members the ability to request an external appeal when all other appeal options have been exhausted. These State External Appeals (SEA) and Federal External Appeals (FEA), must be performed by an Independent Review Organization (IRO) like AllMed.

All of our specialty-matched reviews are conducted by board-certified specialists and sub-specialists who are in active practice. Each appeal review is performed in compliance with URAC, NCQA, CMS, state and federal regulations, which are subject to oversight and audit through our quality and compliance programs.

Superior Quality That Makes a Difference

All of our services are deployed through the AllMed PeerPoint advanced medical review portal, which embeds healthcare intelligence and automation tools that produce the highest-quality reviews at industry-leading turnaround times and costs.

But what really makes us different is our people. Our commitment to consistently exceeding our clients’ expectations through everything we do, is why our clients remain loyal partners, year-after year. This is because of the special care we take to recruit the highest-quality talent as well as train, grow and engage them in our Lean management system. As a values-based company that puts culture first, our employees care deeply about each member’s health and about delivering the highest-quality care.