What is an IME and why it it used in Claim Reviews?

The entire claim review process can be subject to legal review at any time.

A Functional Capacity Evaluation assesses a person’s physical capabilities in relation to their job responsibilities. Learn why this matters while reviewing a disability claim.

There are times when a disability claim is rightfully denied based on the medical evidence. However, there are also instances when a denial results in an appeal or other costly follow-up actions because the initial submission lacked sufficient documentation to support the claim.

A third party review protects the integrity of the overall process and program.

Recommendations made by experts in the diagnosis under review can make all of the difference.

Taking the additional step in requesting additional documentation where gaps are present can be the difference between an accurate or inaccurate determination.

“Two eyes are better than one!”

Independence matters as much as the expertise of the Reviewer.

What unique things should you consider for claims regarding mental health?

Knowing when to elevate a case to a peer reviewer ensures the right level of clinical scrutiny, especially in high-risk or borderline scenarios.

Disability Claim: When the time matters most.

What gaps exist in claim documentation that hold up the process of accurate determinations, or potentially compromise an accurate outcome?

Learn the critical reasons that Disability Reviews support benefit plans.

What is a FCE and what place does it have in a Disability Review?

Learn why independence in the Disability Claim Review process is so critical.

By combining clinical insight with an understanding of the disability process, RNs ensure the review is comprehensive, consistent, and clinically sound.

When evaluating disability claims, the language of the policy plays a critical role in the outcome. One key piece is understanding “Any Occupation” vs “Own Occupation” and how they fit into the Disability Standard under review.

It’s more than just a tagline. It’s a reflection of our commitment to doing things differently in the disability review industry.

At Managed Medical Review Organization, Inc. (MMRO), quality, integrity, and accountability are at the core of everything we do. That’s why we’re proud to be a URAC-accredited Independent Review Organization (IRO) which is a distinction that represents more than a title. It’s a promise.