H  E  A  L  T  H      M  A  N  A  G  E  M  E  N  T

FOCUS Health Services is the nation’s leading URAC accredited, Independent Review Organization (IRO/ERO) with specialization in behavioral health and musculoskeletal health management.  Founded in 2002 in St. Petersburg, Florida, FOCUS currently services more than 50 US health plans covering more than 80 million lives nationwide.


FOCUS offers a large, seasoned panel of actively licensed and practicing UR/Peer Review providers, including psychiatrists, psychologists, orthopedists, neurosurgeons, anesthesiologists, physiatrists, physical therapists and occupational medicine specialists.  FOCUS’ Peer Reviewers conduct more than 100,000 reviews each year, using the health plan’s evidence based criteria, for delegated and non-delegated initial reviews, peer consultations, and appeals for pre-service, concurrent UR Reviews and post-service requests for authorization of services.  FOCUS’ concordance rate (MD Reviewer agreement with the health plan’s CM) typically exceeds 90%.  FOCUS currently has ample Peer Reviewer capacity, and continues to add UR physicians on a regular basis to increase capacity.


FOCUS’ unique strengths include our popular, secure, web based Review Management System that more than 3,000 health plan CMs use today nationwide to quickly and easily submit, monitor and automatically retrieve cases to and from FOCUS for review on a 24/7 basis.  FOCUS offers the benefits of this application to your organization at no additional cost to the plan.

WELCOME TO FOCUS

Specialized UM Reviews

FOCUS continually enhances our service offerings to exceed the evolving expectations of payers for improvements to medical management, physician consensus and increased medical savings, while advancing the standard of care for patients.  To learn more about FOCUS’ specialized programs, we welcome you to tour our website and invite you to contact our National Service Center at 866-344-7791 to learn more about the ways in which our seasoned team of professionals can improve your clinical and financial outcomes to care.

MANAGED CARE SERVICES

√ Pre-Authorization UR Reviews
√ Concurrent UR Reviews
√ Post-Service (Retro) UR Reviews
√ UM Review Appeals
√ Peer Consults (Matched Specialty)
√ Disease Management
√ Network Management
√ Claims Management
√ Quality Management
√ Reporting & Informatics
√ Fraud, Waste & Abuse