IMX Medical Management Services is a URAC-accredited independent review organization (IRO). Our Medical Record Review Services are part of our Cost Containment Program that IMX provides to respond to our clients’ questions regarding work capacity, causality, reasonableness of care, treatment necessity, preventive care options, or patient care management. Our record review processes meet rigorous URAC Standards as well as state and regulatory requirements. IMX works with a variety of governmental agencies, large health and casualty insurers, and benefits administrators to deliver a myriad of quality reviews.

Our expert panel of independent reviewers includes not only physicians, but a host of other ancillary health care professionals who have vast experience and expertise and can assist our clients in resolving complex medical and legal cases. All of our physician reviewers are board certified by member boards of the American Board of Medical Specialties (ABMS) or the American Osteopathic Association’s Bureau of Osteopathic Specialists (AOA). The medical department at IMX can help you determine the most appropriate experts for your case and circumstances, including both state and/or specialty matching.

Our reviewers’ opinions are grounded in evidence-based medicine and clinical research, which serves to ensure the integrity and defensibility of our reports. IMX has extensive experience with both complex and expedited reviews (i.e., reviews requiring turn-around times of 24 to 72 hours).

Types of Reviews

• Independent Medical Reviews
  • An Independent Medical Review is a process where expert independent medical professionals are selected to review specific medical decisions made by the insurance company or employer regarding claims determinations. We currently hold certifications to perform Independent External Reviews in ten states: Arkansas, Colorado, Idaho, Indiana, Maine, Nevada, Oklahoma, Pennsylvania, South Dakota and Wyoming.
  • These reviews determine treatment guidelines regarding:
    • Medical Necessity
    • Experimental / Investigational
    • Administrative / Plan Language
    • Cosmetic Treatment or Surgery
    • Facility or Out-Patient Length of Stay
  • Types of Independent Medical Reviews
    • External Reviews (Level 3)
    • Internal Reviews (Level 1 and 2)
       
• Peer Reviews
  • A Medical Peer Review is a process whereby providers evaluate the quality of work
    performed by their colleagues, in order to determine compliance with accepted health care standards. This review is generally a retrospective consideration by a medical professional of equal standard.
     
• Utilization Reviews
  • A Utilization Review is a type of review performed to determine the necessary, appropriate, and efficient allocation of health care resources and services given or proposed to be given to a patient. Review may be conducted concurrently or retrospectively. This process uses objective clinical criteria to ensure that the services are medically necessary and provided at the appropriate level of care.
     
• Workers’ Compensation – Utilization and Peer Reviews
  • The reasonableness or necessity of all treatment provided by a health care provider under the Workers’ Compensations act may be subject to prospective, concurrent or retrospective utilization review at the request of an employee, employer, or insurer.