Obtain World-Class Services
MCMC’s superior metrics, including best-in-class turn-around-time, quality assurance process, service delivery, and 24/7 report coverage continue to lead the market for nearly four decades.
MCMC Offers Physician and Expert Review of all Levels of Appeals, Coding, Billing, Quality of Care, and Fraud.
MCMC provides independent, objective, and credible information for healthcare decision-making for health plans, patients (consumers), purchasers, payors, business partners, agents, and providers by providing quality, timely, cost-effective independent medical reviews, managed care services, and related services.
MCMC offers physician and Allied Health specialist reviews serving National Group Health Insurance Carriers, Third-Party Administrators (TPA), Disability/IME carriers, Pharmacy Benefit Managers (PBM), Government and State agencies, Special Investigation Units (SIUs), Hospital Quality and Compliance, and Workers’ Compensation.
Peer Review Services
GROUP HEALTH
- Initial and Appeal Level Review
- Fraud Waste & Abuse/SIU
- Retrospective Review
- Quality of Care
DISABILITY
- Short Term Disability
- Long Term Disability
- Permanent –Total
- Disability
- FMLA
- Panel
STATE AND FEDERAL EXTERNAL
- State Level External Review
- Federal Level External Review
- Patient Protection and Affordable Care Act (PPACA) Appeal Review
WORKERS' COMPENSATION
- Medical Necessity
- Causation
PHARMACY
- Clinical Prior Authorization
- Clinical Prior Authorization Appeals
- Formulary Exception Reviews
- Drug Utilization Review
IME Services
Disability
- Short Term Disability
- Long Term Disability
FMLA
- FMLA 2nd Opinion
- FMLA 3rd Opinion
Independent Dispute Resolution (IDR) Process
MCMC is a Certified IDR Entity!
The "No Surprises Act" creates new protections against out-of-network balance billing and establishes a new process, called the independent dispute resolution process, which providers, emergency facilities, and health plans can use to resolve payment disputes for certain out-of-network charges.
The Department of Health and Human Services, the Department of Labor, and the Department of Treasury have certified MCMC Services, LLC to serve as an independent dispute resolution entity in the federal independent dispute resolution process between providers, facilities, or providers of air ambulance services and group health plans, health insurance issuers, and Federal Employees Health Benefits program carriers.
IDR Process Inquiries Email Us Here- IDRFederal@mcmcllc.com
For IDR Payment/Refund Questions Please Email Us Here- IDREAccounting@mcmcllc.com