Review Services

AFMC’s original role was providing peer review for Medicare and, later, Arkansas Medicaid. Medical review is difficult but necessary in order to make the most of each health care dollar spent and ensure that limited resources are used wisely.

AFMC performs a variety of prior authorization and retrospective reviews for Medicare and Arkansas Medicaid. The initial screening review is performed by a review coordinator. If the review coordinator cannot approve an admission, length of stay or procedure, the case is referred to a physician advisor. Only a physician can make the decision to deny coverage of an admission, length of stay or procedure. Physicians and patients may request a reconsideration within a certain time period — usually 35 days — when payment is denied.