Rising’s physician reviewers have the proper experience, licensures, and qualifications needed to verify the medical necessity and appropriateness of treatment plans.

Evidence-Based Decisions, Confirmed

Helping payers reduce unnecessary care and medical costs, this effective utilization management tool can be used as part of Rising’s comprehensive care management programs or as a standalone service.

Here’s what you get with our Peer Review capabilities:

  • URAC Accredited
  • Prospective, Concurrent, and Retrospective reviews
  • Pharmacy / Drug Utilization reviews
  • National panel of credentialed, board-certified physicians
  • Reviews conducted by physicians of the same specialty, ensuring their ability to handle the specific questions and issues related to the request
  • Evidenced-based evaluations, using national or state-specific clinical guidelines
  • Required for Utilization Review services when modifying or denying treatment

Peer Review Services: