Medical Review

Independent Physician Network’s (IPN) Medical Review Committee convenes quarterly to review the clinical and quality aspects of care important to all member physicians, including conducting provider appeal reviews. For example, the Committee reviews clinical and claim data provided by the health plans to identify trends and recommend improvement strategies. The Committee not only supports and encourages the requirements and standards mandated by the health plans, Medicaid and Medicare, it also works with the IPN staff to insure those standards are upheld by all IPN member physicians. The Medical Review Committee is responsible for providing oversight for clinical operations and evaluating and monitoring Utilization Management activities on an annual and continuous basis.

The Medical Review Committee ensures that all IPN member physicians maintain good standing. The Committee is important for all member physicians and other healthcare practitioners as it conducts provider appeal reviews and considers aspects such as:

• Unusual practice patterns
• Providers with multiple member complaints
• Providers with complaints regarding significant quality of care issues
• Appeals or potential fraud issues

By following appropriate policies and procedure, as well as promoting the IPN mission statement to provide high-quality care at an effective cost for all patients, we can ensure all member physicians are in good standing. Through our mission statement and high standards, IPN supports and encourages independent practitioners.

Currently, the Medical Review Committee is comprised of nine IPN member physicians who practice in various specialties, as well as the IPN Medical Director, Assistant Medical Director, VP of Medical Affairs, Director of Quality and Clinical Services (non-voting), and CEO/Executive Director (non-voting). The Medical Review Committee reports directly to the IPN Board of Directors.