This is the essence of peer review - that healthcare professionals are the most qualified persons to assess the appropriateness and necessity of medical care delivered or requested by other clinicians. Reviewer Training Reviewers selected are trained in medical review. This includes medical necessity and medical appropriateness, and whether a specific medical service is experimental or investigational. Decisions are monitored and reviewed by the 3CI Medical Director and staff. Reviewers' decisions must be reasonable and consistent with currently acceptable medical practices, with the recognition that there may be more than one pathway to appropriate treatment.
Reviewers receive compensation for the completion of an external review regardless of the outcome.
In Process 3CI is seeking accreditation as an External Review Organization through URAC, also known as the American Accreditation HealthCare Commission. To achieve accreditation, 3CI must demonstrate compliance with rigorous standards designed to ensure that the external review process is fair, objective and timely. Value of External Review External review is an essential tool in balancing the patient's need for care with the financial obligations of health plans. The involvement of physicians and other medical professionals in the decision making process helps to maintain patient confidence in the healthcare system and also improves the quality of all medical care. Qualifications MRNC employs a highly qualified staff of health information management professionals, physicians, nurses, epidemiologists, biostatisticians and administrative personnel to meet its obligations to clients.