Compliance of Our Review Services

EXECUTIVE PROGRAM LEADERSHIP

Navigating the complexities of federal and individual state healthcare regulatory environments is an evolving challenge. NEXUS recognizes a solid, informed compliance program is crucial for every client, in every vertical market we serve, in every location across the nation.

Experienced compliance program leadership is essential for ensuring that all processes comply with all applicable regulations. We created the role of Director of Compliance, who supports our team, our physician expert panelists, and our clients in staying up to date with all state and federal mandates and URAC best practices for independent clinical review.

 

LICENSURE IN ALL STATES

Compliance at the federal level is a must; under HIPAA, we are defined as a Business Associate and must provide specified safeguards. However, compliance to state healthcare regulations is also a requirement. Individual state healthcare mandates present a unique challenge simply through their variety.

Many providers of independent clinical review services choose to operate in a single state, or small subset of states, to manage their required compliance efforts. NEXUS operates nationwide, and must maintain licensure in every state as required. We also nurture physician expert panelists in each state where we operate, licensed by their state to practice in their medical specialty.

 

QUALITY ASSURANCE

At NEXUS, we have spent thousands of person-hours refining our process and our independent clinical review platform for efficiency, quality, and reliability. Quality assurance is an ongoing process as client needs and regulatory compliance demands are constantly changing.

Our Quality Assurance Director leads efforts as voice-of-client in quality oversight. In addition to responding in real-time as quality issues are discovered, we also perform an annual operations assessment to ensure end-to-end quality. We never have and never will compromise on quality.

RELY ON OUR COMPLIANCE EXPERTISE

Compliance help us connect quality with outcomes - let us show you how.