Compliance Consulting

Two years reviewing both medical and behavioral health claims under InterQual and MCG at a major US commercial payer. The MHPAEA test — are BH criteria more restrictive than analogous M/S criteria for comparable conditions? — is the exact comparison a UM reviewer makes on every behavioral health claim. No one outside a payer UM operation has this applied experience. LLB-in-progress adds regulatory fluency that pure clinicians lack, making the deliverable bilingual: clinical and regulatory.