IMEDECS State and Federal Services

State and Federal Government Information:

The mission of IMEDECS is to provide independent, informed expert medical review services that resolve coverage disputes or evaluate the quality of care. Through its medical review program, IMEDECS is dedicated to quality healthcare and improved clinical outcomes. IMEDECS provides the following services to assist state and federal government entities in ensuring that care is necessary, timely, delivered appropriately and billed appropriately.

Quality of Care Reviews - address and/or prevent medical errors as well as unintended outcomes by assessing the quality of care that medical practitioners are providing. Reviews can be performed for educational purposes and process improvement, for privileging purposes, or as part of an investigative process.

Coding Reviews - IMEDECS provides coding review services for health care providers and managed care organizations. Using Certified Professional Coders (CPCs) trained in a variety of disciplines and with medical specialty expertise, as appropriate, we can help you maximize your health care billing or assess over-billing. IMEDECS reviews clinical, billing, and reimbursement documentation as well as nationally accepted and payor-specific standards in making determinations.

Case Reviews (Medical Appeals) - medical record reviews that address the medical necessity or experimental/investigational status of a treatment or procedure. These reviews:

May address whether a treatment or procedure is a covered benefit under the enrollee's plan

Can be provided at a pre-appeal, internal or external level; prospectively or retrospectively

Are performed by an expert in the same or similar specialty as that of the treating provider

Reviews cover all types of medical issues and physician specialties, including but not limited to:

Ambulance
Behavioral health claims (inpatient or outpatient)

Chiropractic services

Cosmetic procedures

Diagnostic tests

DME

Experimental treatments

Home Health Care

Inpatient stays - No. of days, level of care

Lab work

Medical procedures/treatments (physician services)

Pharmacy claims

Skilled nursing

Surgery

Therapy (PT, ST, OT)

Transplants

IMEDECS Federal Services and Experience

Department of Justice: Expert Medical Reviews for National Fraud Cases
Health and Human Services: Sub-contractor to the DME QIC for CMS

IMEDECS State Experience

Colorado
Delaware
District of Columbia
Illinois
Indiana
Louisiana
Massachusetts

Nevada
New York
Ohio
Oregon
Pennsylvania
Washington

Address:	IMEDECS 157 S. Broad Street Lansdale, PA 19446 USA
Phone:	215.855.IMED (4633)
Fax:	215.855.5318
DUNS:	126424550
CAGE/NCAGE:	3MWV6
NAICS codes:	524298, 524291, 541611, 541612, 541618, 641690, 541720, 541990, 621111, 621112, 621210, 621310, 621320, 621330, 621340, 621391, 621399, 621999, 813920, 923130