After reading the disclaimer below, click here to view our Service Request Form, which you can print out, fill in and fax back to us at 215.855.5318.

Disclaimer:

Due to varying state and health plan requirements, this website may not be used to initiate an independent medical review. To request a review, contact your health plan or your state insurance or health department.

Only an authorized representative of a health plan or state government may use the Service Request Form to initiate an independent medical review.

How to Initiate a Case Review

Thank you for allowing IMEDECS to assist you with your case review needs. The following information provides an understanding of the case review process at IMEDECS and enables us to provide the most effective and efficient service possible.

Getting Started

  • 1. To initiate a case review, please fax the completed IMEDECS Service Request Form to our office at 215-855-5318. It is necessary to have complete information to clearly understand your request and to screen for conflicts of interest.
    • 1. If you wish to have the report sent to the enrollee and or treating physician please specify this and provide their complete address and phone number.
    • 2. Please be sure to write the question(s) exactly as you would like them posed to the expert.
  • 2. Contact one of the administrative assistant(s) at IMEDECS to verify receipt of the Service Request Form and ask any questions you may have. If necessary, you will be transferred to a Case Review Manager. Receipt of the Service Request Form allows IMEDECS to initiate the case review process.
  • 3. A case manager will review the service request form and will contact you if additional information is required.
  • 4. For expedited reviews, please contact the IMEDECS office immediately via phone at 215-855-IMED (4633). Advance notice is greatly appreciated and essential to completion of the review in the required time frame. This also allows IMEDECS to initiate expert reviewer panel selection and begin the process.
  • 5. Information needed during the call for an expedited review is as follows:
    • Patient's name, age, sex
    • Diagnosis(es)
    • Treatment, procedure, or drug under review
    • Treating facility name and address
    • Treating physician name, address, phone number and specialty
    • Time frame for return of review
    Please follow up by immediately faxing the completed service request form.
  • 6. For expedited reviews, if the records are 50 pages or less and faxable, we ask that you fax them immediately to 215-855-5318. For records 50 pages or more, please contact the IMEDECS office.
  • 7. For standard reviews, IMEDECS asks that the health plan send copies of medical records via overnight delivery to the IMEDECS office. Please send the records as soon as possible after faxing the completed service request form.
    • a. In order to maintain patient confidentiality, all documents containing patient information should be enclosed in a separate envelope marked private and confidential inside the delivery envelope.