Make every citizen interaction with your program count
Respond to the growing demand for assessments
Resolve benefit disputes with a nonjudicial approach
Modernize your program, adapt to changing needs
Make services easier to access, ensure program integrity
We render fast, independent, accurate determinations through a combination of trained health professionals, optimized process and enhanced technologies that streamline the most complex review programs.
benefit appeals completed annually
healthcare professionals contracted on our panel in the US
taxpayer savings per year attributed to IMR for the California Workers' Compensation program
We offer government the expertise and capabilities to review and disposition appeals from virtually any government agency or government-sponsored service, including eligibility, health, disability, and workers’ compensation.
Our clients have access to more than 2,000 independent health care providers and reviewers representing every recognized medical specialty and major licensed practitioner categories.
We contract with medical directors, health attorneys, pharmacist-attorneys, nurse-attorneys, nurse professionals and podiatrist-attorneys.
As the largest provider of government-sponsored benefit appeals programs in the United States, MAXIMUS offers government the ability to handle massive scale in any program area that requires appeal support. Our business model features document digitization, case management systems and appeal operations support.
Our experts apply cutting-edge technologies with nearly three decades of independent review and quality assurance experience - enabling us to deliver proven solutions that simplify the most complex review processes. Our objective is ensuring the best possible outcomes for citizens and the government by rendering accurate decisions quickly.
Developed as part of California's efforts to reform and control medical care and indemnity benefit costs in the workers’ compensation system, our independent medical review (IMR) solution resolves disputes about the medical treatment of injured employees. Individual cases are routed to an independent healthcare professional who is screened to ensure he or she has no conflict of interest with the parties in the case. With the introduction of IMR, disputes are resolved in 2 weeks on average - down from nearly 12 months under the cumbersome court system it replaced.
cases processed per month for California's program
Since 1989, the Centers for Medicare and Medicaid Services (CMS) have relied on us to provide Medicare beneficiaries and providers with independent, conflict-free appeal decisions of health insurance denials. Today we receive more than 600,000 appeals claims a year for Medicare Parts A, C and D.
We are a certified Quality Improvement Organization-like entity
Our appeals work extends to virtually any government service, including eligibility, health, disability and workers’ compensation. Our appeals work includes hundreds of thousands of appeals annually from the following contracts: