Independent Review Services

Meeting the Independent Challenge One Case at a Time

Meeting your medical review needs can be a challenge.
HQSI has the expertise and experience to help.

Nancy Mendes, RHIT, Director, Special Projects

With more than 30 years experience handling independent medical reviews, Nancy Mendes, RHIT, Director, Special Projects, (nmendes@hqsi.org) leads a dedicated staff at HQSI with the single goal of providing top-level independent medical review services that are timely, cost-effective and free from conflict of interest. Using the right specialists, HQSI’s Independent Review Organization (IRO) reviews are promptly performed by more than 150 actively practicing board-certified physicians that focus on the right decision, every time.

As a URAC-accredited IRO for internal and external appeals which has performed more than one million independent reviews, HQSI has the expertise and experience to quickly and confidently handle reviews in the areas of:

  • medical necessity
  • appropriateness of setting
  • level of care
  • quality of care
  • experimental treatment/procedures
  • coding
  • DRG assignment

Our clients include hospitals, managed care organizations, third-party administrators, employer groups and federal NAIRO Logoagencies. Our satisfaction surveys indicate that 100% of our clients continue to be extremely satisfied with our services.

We strictly adhere to URAC standards for ongoing quality control and training for our staff, physicians and healthcare consultants to ensure the highest standards of review are consistently met. It also guarantees the most stringent protocols with respect to quality assurance, HIPAA/HITECH compliance, and code of ethics.

To ensure compliance with the latest regulatory requirements under the Patient Protection and Affordable Care Act, contact Nancy Mendes at the email above or by calling 1-732-238-5570, ext. 2039.

Want to be an independent medical file reviewer?

Physician reviewers are urgently needed for independent medical file review in the following areas:

  • ENT
  • Geriatrics
  • Hematology
  • Nephrology
  • OB/GYN
  • Psychiatry/Addiction Medicine
  • Pediatrics - General
  • Pediatrics Specialties -All
  • Rehabilitation Medicine
  • Urology

Most reviews can be conducted electronically, in the comfort of your home/office, no travel required. Apply here.