Medical Audit & Peer Review Services

Medical Audit Review, Peer Review & RN Medical Coding Services

Our Services

Medical Audit and Peer Review Services for CMS & Commercial Health Plans

Medical Audit Peer Review
Close-up of a healthcare professional examining medical records with a pen.
Close-up of a healthcare professional examining medical records with a pen.

Delivering accurate, compliant medical reviews for CMS programs, Medicare, Medicaid, and commercial health plans.

  • Physician and specialist reviews

  • Medical necessity determinations

  • Level of care reviews

  • Appeals and dispute support

person holding pencil near laptop computer
person holding pencil near laptop computer
Two clinicians discussing clinical documentation in a bright office.
Two clinicians discussing clinical documentation in a bright office.
Fraud, Waste & Abuse (FWA) Investigations

Clinical audit and review services help healthcare organizations detect and prevent fraud, waste, and abuse.

  • Clinical review of suspected fraudulent or abusive billing

  • Medical necessity validation

  • Documentation review and analysis

Certified RN & Professional Coding

Program Integrity

Program Integrity is the foundation of effective healthcare oversight. Our clinical experts, licensed physician auditors, RN medical coders, and certified professional coders help health plans, government agencies, and healthcare organizations detect fraud, waste, and abuse; validate medical necessity and coding accuracy; ensure regulatory compliance; and protect the integrity of healthcare programs through independent, evidence-based medical review services.

RN Certified and certified professional coders work to identify fraud, waste, and abuse for CMS and commercial healthcare organizations nationwide

  • Validate coding, billing, and documentation compliance.

  • Identify FWA and coding discrepancies

  • Support program integrity and compliance