Proposed criteria for independent peer reviewers.
Because of the complexity of craniomandibular claims, it is difficult for insurance adjusters to keep up with all of the advances and techniques regarding craniomandibular disorders. Insurance companies have found that they can process claims more quickly and economize by having claims reviewed. Because of this, independent insurance reviews have become routine for TMJ claims. Many practitioners contend that the current review system appears to be lacking in impartiality, criteria for reviewers, and standardized fees for various geographical locations. The author offers suggestions for objective reviews that ensure the use of qualified and responsible reviewers. Setting guidelines for reviewers will bring about more equitable reviews and assist in dismantling the confusion surrounding head and neck claims.
Nierman
R N
RN
D006801:Humans; D007345:Insurance Claim Review / Q000592:standards*; D010380:Peer Review / Q000592:standards*; D013705:Temporomandibular Joint Disorders