Peer Reviews for Health Plans – Why They Are Important

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Peer Reviews for Health Plans – Why They Are Important The medical peer review process is a significant one that is performed to make sure that the clinical care provided is medically necessary and appropriate.

Medical peer review for insurance involves a physician-level review of the claimant’s medical records by a health plan to decide whether or not to uphold a denial of coverage for a specific claim. Typically, these reviews are conducted by a healthcare professional belonging to the medical specialty associated with the attending physician (s) who provided the medical services.

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