Reliable Review Services (RRS) has a credentialed panel of peer review doctors from all states, specialties and sub-specialties to determine medical necessity and appropriateness of medical treatment and services in the Utilization Review (UR) and Utilization Management (UM) setting. Utilizing current medical literature, plan documents or other recognized guidelines, RRS provides peer review services for many claim types including: Medical Necessity, Experimental/Investigational, Federal External Review (PPACA), State External Review, and SIU/Fraud Waste and Abuse.
Reliable Review Services (RRS) has a credentialed panel of peer review doctors from all states and specialties to determine medical necessity and appropriateness of medical treatment and services. Utilizing state guidelines, official disability guidelines, and or current medical literature, peer review reports are provided to meet the strictest of turn-around time requirements and standards of quality.
Reliable Review Services (RRS) Long-Term Care business helps meet the needs of people whose activities of daily living (ADLs) have been limited by long periods of chronic physical or mental disorders.
Disability plans are serviced through independent peer review, which provides clinical expertise to support plan decisions. Reliable Review Services (RRS) provides these services to the short-term disability, long-term disability, disability pension, and salary continuation markets.
Independent peer review helps you to provide the claimant with a full and fair review that is impartial and promotes consistency and fairness. Reliable Review Services (RRS) uses the best quality assurance process, professional clinical resources, and overall best practices.
The Employee Retirement Income Security Act of 1974 governs the majority of group employer STD, LTD, life and health insurance policies, and self-funded plans.
Accidental Death and Dismemberment
Reliable Review Services (RRS) offers comprehensive medical reviews to evaluate the autopsy record, ambulance records, hospital/emergency room records, and witness statements in order for a plan to make an appropriate determination.
Accidental death insurance is a special type of policy that provides payments when a person dies as the result of an accident. It is usually combined with a dismemberment policy and will provide benefits when a person loses certain parts of his/her body or the ability to use those body parts because of an accident.
RRS applications are housed in one of the most secure platforms in the industry which streamlines work flow, enhances communication, and provides secure access for client review, ultimately enabling reduced case turnaround times. Workflow enhancements embedded in our referral processes include:
- Simplified data transmission, file upload and management
- Automated functions that reduce human error
- Customized billing and e-billing functionality
- Pro-active cyber security, defense reviews and audits
RRS has redundant network operations at data centers that we manage and maintain.