Medical Review

StrategicHealthSolutions, LLC (Strategic) provides medical review that supports several services, including Medical Management policy review, compliance with benefit and coverage regulations, billing and overpayment calculation, fraud case support, expert testimony, appeals and grievance support, and coding validation. Decisions are based on defined criteria, which are supported by regulation and meet high standards of quality.

Our team’s knowledge, skills, and experience ensure our ability to conduct a thorough analysis of medical record documentation. This expertise also is used to validate that medical services are rendered consistently with Medicare and/or Medicaid coverage guidelines and are medically reasonable and necessary.

Services

  • Review of Medical Management policies, including quality of care review, Utilization Management, Case Management, and Disease Management
  • Medical Compliance Review
  • Overpayment calculation
  • Fraud case support
  • Appeals and grievance support
  • Code validation
  • The Strategic Advantage
  • Work approach based on customer preference
  • Known and trusted process
  • Detailed review results that withstand scrutiny
  • Consistency through a proven quality assurance process