(Federal and State)
Medical Necessity Reviews
Quality of Care Review
Group Health Services
Independent Medical Reviews
Group health insurance plans across the nation help millions of employees and their families stay healthy and productive. When plan coverage disputes arise, our clients rely on Nexus to support their utilization management and appeals process effective, accurate independent medical reviews. We support all levels of review including Independent Peer Review, Pre-Certification, and Internal and External Appeals.
Nexus group health services support our client’s group health plan management strategy by ensuring members receive quality care that is medically necessary and appropriately covered. Our solutions help plan sponsors successfully navigate the complex state and federal regulatory requirements with clinically-sound independent medical reviews.
The Clinical Experts
Our Group Health Services Include:
Specialty Pharmacy Carve-Out
Drug Regimen Reviews
Standard of Care Reviews
YOUR MODEL, OUR PLATFORM
Every aspect of our platform has been honed for efficiency, sustained by our state-of-the-art utilization review portal. Our physician portal was designed to optimize the reviewer’s expertise and reduce the administrative burden for all panelists and clients. Our customize client portal allows easy access real-time case information and determinations, rendering evidence-based decisions quickly and streamlined so your team can efficiently handle claims.When group health determinations flow quickly and accurately, members are delivered appropriate care they need.
STREAMLINE YOUR GROUP HEALTH PLAN APPEALS
Achieve both quality care and plan alignment with our group health services.