Peer Review software

The client is a leading US-based behavioral healthcare services company providing behavioral health and medical review services to health plans, health systems, hospitals, and other insurers nationally. As an independent review organization (IRO), they act as a third-party medical review resource, providing objective, unbiased medical determinations to insurance payers and providers. Their peer review software supports effective decision-making, based on medical evidence, and helps clinical and claims management professionals better allocate healthcare resources.

The client’s existing software had several bugs and missing features that failed to meet the evolving needs of their business. The application was built using outdated technologies, leading to usability and reliability issues, and there was a shortage of resources and skillsets to maintain the software. Moreover, it lacked robust security features, which made the system vulnerable to security threats and put sensitive data at risk.

The requirement was to redesign the custom-developed peer review software with enhanced features and implement a reporting tool to carry out tracking and analysis of various peer review activities.

Experion’s expert team of developers and solution architects redesigned the fully custom-developed software for reviewing behavioral health and medical services. Developed using ASP.NET, the clinical peer review management application acts as an administrative backbone for an array of behavioral health and medical review services. It stores, organizes, formats, monitors, and prepares cases for review.

Experion is the sole development team responsible for both resolving bugs and managing the ongoing development of the peer review software. We have worked on fine-tuning the app to make it more effective using .NET resources and re-engineered features such as bulk upload while ensuring HIPAA compliance. We also developed a customized reporting tool that tracks key metrics for internal process improvement and compliance, and we integrated stacks of case management tools into a single focused interface.

The application makes it effortless for medical directors to process and review cases by channeling case information into a standard format that is consistent and easy to read. This streamlined approach helps organizations improve the speed and efficiency of their software processes.