Quality Review Services

Quality Reviews evaluate performance as related to clinical practice or utilization management responsibilities. These reviews assist in determining clinical privileges and provider network membership. All reviews are performed by an expert medical practitioner of the same or similar specialty as that of the treating practitioner.

Quality of Care Review

• Focus on the quality of care rendered by medical practitioners
• May be initiated by a health plan, insurer, physician network, hospital, or medical facility
• Reviewers consider generally accepted practice guidelines developed by the federal government, national or professional medical societies, boards and associations
• Address issues related to patient safety, medical errors, and unintended outcomes
• May be performed in conjunction with performance evaluation, credentialing and continuation of hospital and procedure-specific privileges