PeerLink Medical

Utilization & Clinical Reviews based on state and recognized treatment guidelines

Pre-certification/prospective review:
This is a review for medical necessity conducted by a medical/clinical professional to determine the appropriateness of future medical care interventions that have been requested by an attending physician.

Concurrent Review:
Utilization management conducted during a patient’s hospital stay or course of treatment. This type of review relates to contemporary interventions during a course of treatment.

Retrospective Review:
This is a medical necessity/appropriateness review concerning interventions that have already occurred. It may relate to medical appropriateness of interventions.

Often with peer-to-peer conversation

When activity restrictions are imposed, our physicians provide an independent assessment of such restrictions OR consolidate different restrictions imposed by different providers

Utilization and Clinical reviews based on specific health plan criteria and standards of care

Initial review services to establish appropriateness of care and compliance

Appeals and disputes

Invetigational reviews to address possible fraud and abuse

Pharmacy and Formulary reviews to address safety and efficiency

Retrospective and prospective medication review

As complex as medication requests may get, there are several factors to consider when reviewing medication requests. Medication interactions, dependency, compliance, weaning or simply monitoring are considerations that are increasingly important in the long-term management of chronic patients. Our pharmacy review services help guide management.

Obtain a quality second opinion for First Party No-Fault & PIP medical claims

Confirm diagnoses, medical necessity, causality and MMI

Address diagnostics, future treatment needs and any pre-existing health conditions

State and specialty matching where required

Peer-to-peer consultations available upon request

State, Federal & Specialized medical review programs

We accelerate government efficiency in healthcare administration with proprietary technology built to service, scale and advance healthcare delivery at the "speed of need".

Selection criteria

What it takes to become a PeerLinkPhysican Advisor

• 1 Current unrestricted licensure as an MD, DO or DPM in the state of California, state of residence, or other state requiring licensure in that state to conduct peer review;
• 2 Board certification in a desired specialty related to the types of cases and the population served by PLM;
• 3 Current active practice status with more than five years of post-residency experience in direct patient care;
• 4 Sanctions and disciplinary history;
• 5 Acceptable malpractice history;
• 6 Adequate availability to meet turn-around time requirements; and
• 7 Previous experience in peer review for medical necessity/ appropriateness preferred.

Currently hiring Physicians

PeerLink is currently specifically looking to recruit these specialties, but we are also hiring Utilization Review Nurses, Pharmacists, or PA's to assist with quality assurance

• 1 Anesthesia/Pain
• 2 PM&R
• 3 Rheumatology
• 4 Orthopaedic Spine Surgery
• 5 Orthopaedic Hand Surgery
• 6 Psychology
• 7 Psychiatry
• 8 Internal Medicine

Why to join our Panel

Joining our Panel comes with many benefits

• 1 Supplemental Income
• 2 Access to the PeerLink Library of Evidence-based medicine
• 3 Refreshing the latest evidence based guidelines criteria
• 4 Optimizing workflow and documentation within your own practice
• 5 Access to Peer-X-Change to make your contribution effortless yet efficient
• 6 Coverage through PeerLink’s E&O group insurance policy
• 7 Access to PeerLink’s Network of Physician Advisors

Library of Evidence-Based Medicine

PeerLink edits and maintains a condensed database of evidence-based criteria

The PeerLink Library of Evidence-based Medicine is the criteria digest that you always wished you would havehad. Based on tens of thousands of conducted reviews, close monitoring of the primary guideline sources per jurisdiction and the latest research, the PeerLink Library is an edited compilation of the most frequently applied criteria.

We make available this resource both to ensure uniform standards across our reviewer panel; but also for your convenience.

With different jurisdictions, emerging research and frequent revision cycles, we have found the PeerLink Library to have become an indispensable tool for our Physician Advisors.