utilization review

Aerolib Physician Advisors provides physician advisor services and an AI-driven platform for hospital revenue cycle management, including denials management, utilization review, appeals writing, and clinical documentation integrity. Founded in 2009, the company offers board-certified physician advisors available 24/7 for concurrent and retrospective case reviews, peer-to-peer support, and Medicare/Medicaid medical necessity compliance.

AI-powered appeal letter generationappeals writing and submissionbed management and patient flow analyticsclinical documentation integrityconcurrent and retrospective case reviewsdenials managementpeer-to-peer supportphysician advisor services

American Correctional Healthcare Inc. (ACH) provides all-inclusive, fully integrated healthcare for correctional inmates, combining healthcare and Federal Bureau of Prisons experience. Founded in 2009 and headquartered in Fort Worth, Texas, ACH services clients nationwide, offering Third Party Administration services, on-site and telemedicine providers, and claims processing with detailed reporting.

claims processinglab servicesmobile imagingOn-site medical staffingPatient management system (PTRAX)telemedicinethird-party administration

Asian Community Care Management (ACCM) provides customized chronic care management solutions for insurers and providers throughout New York, New Jersey, New Hampshire and Maine. Founded in 2013, ACCM is an approved Utilization Review Agent under the New York State Department of Health and partners with managed care organizations, commercial insurance providers, and health homes.

care coordinationcare managementCommunity Health Worker trainingremote patient monitoring

Beam Healthcare is a Joint Commission Accredited telemedicine clinical group providing tele-specialist, tele-hospitalist, tele-RT, and tele-case-management services to community hospitals, clinics, and PACE organizations. It offers a dedicated core team of providers, multi-specialty access with hospitalists, and aims to reduce transfers to outside organizations while tackling rural and urban healthcare disparities.

care coordinationER census monitoringinpatient specialty consultsprocedure interpretationtele-case-managementtele-hospitalist servicestelemedicinetele-RTtele-specialty clinics

C3 is a small, boutique revenue cycle management firm founded by two hospital revenue cycle leaders. It specializes in revenue cycle and payor operations for hospitals and physician groups, offering outsourced patient access, denial management, payor audit defense, reimbursement audits, and specialized consulting services.

denial managementinterim managementoutsourced patient accesspayor audit defenseprocess improvement consultingreimbursement auditsrevenue cycle managementsoftware migration and optimization

ClarityCare AI builds AI agents for healthcare utilization management, including its Electra agents that process prior authorizations, pharmacy benefit approvals, and concurrent reviews. The company states its agents read clinical documents, apply medical criteria, and produce cited recommendations with audit trails, and that it is HIPAA compliant and SOC 2 Type II certified.

AI agentsaudit trail generationclinical document processingCMS-0057-F and NCQA complianceprior authorization automation

Family Medical Transport is a Charleston, SC private ambulance service and licensed Advanced Life Support (ALS) provider through SC DHEC. Its team of healthcare providers has over 75 years of patient care experience across 911 transport, emergency room and trauma center, hospital floor, and routine patient transport. It provides emergent and non-emergent transport, ALS and BLS transport, wheelchair transport, and hurricane and disaster evacuation.

ALS transportBLS transportcompliance consultingdisaster evacuationmedical billing consultingwheelchair transport

HealthSkil is a CMS-approved, QIO-like Entity that provides talent and structured programs to help healthcare organizations, payers, and public health entities meet regulatory and care-delivery deadlines. It offers quality improvement, utilization management, program integrity, and population health services, and is described as a division of The CK Hobbie Group.

clinical documentation auditsData AnalyticsHealthcare staffingprogram integrity oversightquality reporting

Integrix provides boutique-quality workers' compensation case management, utilization review, and field investigation/outside adjuster services. Its team of nurses and claims handlers takes a proactive approach to expedite claims to closure, improve access to appropriate care, and prevent unnecessary litigation while containing overall claim costs.

Bill Review and NegotiationContract negotiation with providersfield investigationnurse case managementNurse TriageOutside AdjustingPeer-to-Peer schedulingPhysician Review