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Medical Review and Appeals

Services You Can Trust

HQSI, an experienced leader in medical review, appeals and dispute resolution for over three decades, focuses on making the right decision the first time — every time. Our expertise is recognized by URAC and the Centers for Medicare & Medicaid Services which certified HQSI as a “QIO-like entity.”

Our independent medical review and appeal services include:

  • medical necessity
  • readmission/combined admissions
  • place of service/level of care
  • experimental/investigational
  • quality of care/peer review
  • coding/DRG assignment/DRG validation.
  • expedited, concurrent and retrospective reviews.

We can also triage appeals to help you determine the value, and feasibility, of each case before pursuing an appeal. By also preparing the appeals for high-value, high-probability cases, we can potentially save you even more time and money.

We work with providers, payers, government agencies and other healthcare organizations to meet their short- and long-term needs. 

HQSI can conduct medical reviews and appeals at any level — first, second and/or third — conflict free. We will also collaborate with you to customize a solution for your organization, drawing from our years of experience and expertise. All our services use:

  • The right clinical specialists; board-certified physicians, who provide clear, concise, conflict-free, and unbiased determinations
  • An intuitive, user-friendly, secure web-based portal that makes it easy to submit cases, track progress, and receive final reports
  • Stringent protocols with respect to timeliness, internal quality control, and training
  • HIPAA/HITECH compliance, security, and code of ethics
  • Credentialed and licensed allied healthcare providers

Contact us to learn more about our independent review and appeals services.

 

Get Started

Whether you have an ongoing or just an occasional case need, we can partner with you.

Call 1-800-752-8420 for more information

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