Commercial
Utilization Management & Appeals for Commercial Health Plans
Prior authorizations, initial reviews and appeals across state and federal processes — delivered by board-certified physicians on time, every time.
What's included
Prior Authorization Reviews
Nurse, pharmacy tech and pharmacist-level reviews for pre-service requests, ensuring timely and clinically appropriate determinations.
Initial Clinical Reviews
Generalist and specialty-matched physician reviews of inpatient, outpatient and post-acute care requests against evidence-based criteria.
Appeal Reviews
First and second-level appeal reviews with full documentation, meeting all state and federal regulatory timeframes.
External Independent Reviews
URAC-accredited external reviews for final binding appeal determinations across group health and individual market plans.
State External Reviews
Contracted with Departments of Insurance in multiple states to support state-mandated external review programs.
Expedited & Weekend Coverage
Rush and expedited review capacity with weekend and holiday coverage to meet your most demanding turnaround requirements.
Who we serve
medlitix supports commercial health plans and managed care organizations of all sizes.
→ Health Plans & Managed Care Organizations
→ Third-Party Administrators (TPAs)
→ Self-Administered Employee Benefits Groups
→ Utilization Management Organizations
Why medlitix for Commercial
Board-certified physicians across 120+ specialties
Meets all state & federal UM timeframes
URAC-accredited IRO
Weekend & holiday coverage available
Ready to streamline your review process?
Submit a referral today or reach out to explore how medlitix can support your team.