Independent medical peer review services are at the core of our business. We understand that the rising cost of healthcare affects everyone, thus the purpose of these reviews is to help keep health care costs down and ensure that patients receive the appropriate medical treatment. P&S Network currently offers IRO services for multiple states and insurance companies. The IRO process helps avoid unnecessary repetitive appeals and provides a conflict-free determination performed by specialty-matched board-certified physicians, which can then be utilized to resolve medical treatment disputes.

P&S Network provides a highly customizable Utilization Management solution. Our credentialed, US-based Nurses follow ODG, ACOEM, or/and any other state-specific guidelines in conjunction with thoroughly analyzing the subjective and objective outcomes in each case as well as the specific medical policies of the carrier, to determine if the requested procedure is medically necessary or appropriate. The P&S Network Level I healthcare professionals interact with requesting physicians and claimants to evaluate medical necessity. Our advantage lies in our integrated technology solution, Smart UR Flow (SURF), which ensures the highest compliance and quality standards as the request goes through various stages of determination. Additionally, our Level I Nurses have access to our board-certified Physicians to deliver the highest quality of determinations.

P&S Network is one of the pioneers in the use of high-cost prescription drugs in Workers’ Compensation and executing innovative solutions to ensure the safe and cost-effective use of medications.  With our extensive knowledge of evidence-based pain management, we work with treating physicians to assist them in discontinuing patients from risky levels of opioids/narcotics.  Your costs are reduced when we identify drugs that should not be billed through workers comp and obtain agreements from providers to substitute generics for expensive brand name drugs.  You will receive a report that includes the agreements reached in the peer to peer call, a clinical summary, and recommendations for future use of medications

P&S Network is an approved IRO by the Office of Inspector General (OIG). We conduct comprehensive reviews of claims submitted to and reimbursed by Medicare and Medicaid programs. We determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claims were correctly coded, billed, and reimbursed. We also conduct independent reviews specific to the requirements listed in the CIA/IA to ensure full compliance.