Advanced Medical Reviews

What Advanced Medical Reviews does

Advanced Medical Reviews (AMR) is a privately held independent review organization (IRO) founded in 2004 by two physicians and headquartered in Long Beach, California. The company provides independent medical case review and utilization management services to U.S. healthcare organizations, including commercial and government health plans, Medicare/Medicaid programs, Workers' Compensation insurers, pharmacy benefit managers, third-party administrators, special investigation units, and case management companies. AMR's service portfolio spans medical necessity determinations, peer-to-peer reviews, multi-level appeals, length-of-stay reviews, quality-of-care reviews, billing and coding audits, and delegated medical director coverage, delivered 365 days per year including weekends and holidays.

The company operates a HITRUST CSF-certified and SOC 2-accredited proprietary client portal that supports case submission, real-time tracking, customizable workflows, and specialized reporting. The portal is paired with a nationwide network of over 1,000 board-certified physicians and allied health professionals across all 50 states, with reviewers required to hold MD or DO credentials and at least five years of post-residency experience. AMR has maintained continuous URAC accreditation as an Independent Review Organization since 2005, added URAC Health Utilization Management accreditation, and achieved NCQA Utilization Management accreditation in 2020, positioning it as one of a small number of IROs holding the NCQA UM distinction.

AMR generates revenue on a per-case transaction-fee basis, with pricing varying by case type, specialty, urgency, and report length. The go-to-market is enterprise field sales targeting healthcare payer and administrator buyers, supported by dedicated account management, free portal demonstrations, trade show presence at AHIP, RIMS, WCRI, and other industry conferences, and a content marketing engine (blog, whitepapers). The company employs 51-100 internal staff, with reviewers engaged as a contracted network rather than full-time employees. No outside funding rounds, acquisitions, or parent company relationships are disclosed.

Name

Advanced Medical Reviews

Legal name

Advanced Medical Reviews, LLC

Website

https://admere.com

Company type

Private

Founded year

2004

Operating status

Operating

Headcount range

51–100 employees

Short description

Advanced Medical Reviews is a URAC- and NCQA-accredited independent review organization that delivers independent medical case review, utilization management, and peer-to-peer reviews to U.S. health plans, Medicare/Medicaid programs, Workers' Compensation insurers, TPAs, and PBMs via a HITRUST-certified client portal and a network of 1,000+ board-certified physicians.

Ownership category

akta.pro rank

Headquarters

HQ city

Los Angeles

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Per-Case Physician Review Services: Physician Reviewers are compensated per case reviewed. Compensation is dependent upon the type of case and report length and time required. Revenue is generated through per-case billing for independent medical reviews, utilization reviews, and peer-to-peer reviews.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels5 records

Core offering

Advanced Medical Reviews delivers independent medical case review and utilization management services to U.S. health plans, group health organizations, workers' compensation insurers, Medicare/Medicaid programs, TPAs, PBMs, and Special Investigation Units. Services are rendered by a network of over 1,000 board-certified physicians across all 50 states and are submitted, tracked, and reported through a HITRUST CSF-certified, SOC 2-accredited AMR Client Portal that is customizable to client workflows.

Product overview

Advanced Medical Reviews (AMR) offers a unified platform centered on the AMR Client Portal, which serves as the core technology for submitting, tracking, and reporting on independent medical reviews. The platform is complemented by an extensive Physician Reviewer Network of over 1,000 board-certified physicians. Services include peer review offerings across multiple segments: Group Health, Pharmacy Benefit Management, Medicaid/Medicare, and Workers' Compensation, each supported by the portal technology. Specialized services encompass Quality of Care reviews, Utilization Management Program Support, Medical Director Coverage, Billing and Coding, and Special Investigation Unit services. All services leverage the same client portal infrastructure and are delivered through a nationwide physician network with state and specialty matching capabilities.

Differentiator

Problem solved

Functional benefit

Products and services

• AMR Client Portal Web-based platform technology enabling healthcare clients to submit, track, and report on physician reviews of all types. Features customizable workflows, quick processing, data mining, and specialized reporting, and is HITRUST CSF-certified and SOC 2-accredited for protected health information security.
• Group Health Review Services Physician-level peer review services for commercial and government-sponsored group health organizations, supporting UM and Appeals Departments, provider quality, and SIU functions including medical necessity determinations, peer-to-peer reviews, guideline reviews, 1st through 3rd level appeals, and length-of-stay reviews.
• Pharmacy Benefit Management Review Services Customizable technology platform and pharmacy benefit review services enabling payers to obtain quick and independent outcomes for prescription drug reviews, with cost reduction through enhanced accountability for PBM clients with growing workloads.
• Medicaid/Medicare Services Delegated Medical Director services for Medicaid and Medicare programs with coverage during and after business hours, on weekends, and on holidays, complying with NCQA and contractual regulations for supplemental medical director coverage.
• Workers' Compensation Review Services URAC-accredited utilization management services applying state-specific clinical guidelines (ODG, ACEOM, and other state guidelines) through physician consultants familiar with workers' compensation nuances, including medical necessity reviews and experimental/investigational status determinations.
• Quality of Care Reviews Evidence-based clinical quality reviews for healthcare systems and providers, leveraging HITRUST CSF certified platform technology and specialty/state-matched physician reviewers to assess quality of care, medical necessity, and fraud/waste/abuse.
• Utilization Management Program Support Full-service UM support from pre-service assessment through third-level final and binding review, including medical necessity determinations, experimental/investigational status determinations, and NCQA-compliant review processes.
• Medical Director Coverage Interim medical necessity review capabilities delivered through a URAC-accredited IRO with physician network coverage across medical specialties and sub-specialties, used by health plans and government programs facing staffing shortages.
• Billing and Coding Review Services Expert assessment of service codes for accuracy, medical necessity, and fraud detection using a combination of medical and billing professionals.
• Third Party Administrator (TPA) Services Independent medical review services enabling third party administrators to provide value-added services without incurring costs of implementing non-core competency processes, supporting cost containment and reinsurer requirements.
• Special Investigation Unit (SIU) Services URAC-accredited IRO reviews for internal and external reviews where physician consultants attest to impartiality in reviewing medical records for fraud, waste, and abuse.
• Physician Reviewer Network Nationwide network of over 1,000 board-certified physicians and allied health professionals representing extensive specialties and subspecialties across all 50 states, available to perform independent medical chart reviews for AMR's clients.

Named customers3 records

Segments7 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Scale indicators4 records

Recent moves5 records

Expansion highlights6 records

Broad incumbents

• Maximus: Maximus operates large-scale federal and state healthcare services businesses including independent medical reviews for Medicare and Medicaid programs, directly overlapping AMR's Medicare/Medicaid delegation services.
• Change Healthcare (Optum): Change Healthcare, now part of Optum, provides clinical decision support, utilization management, and payment integrity services to payers - overlapping AMR's clinical review and decision support capabilities at a much larger scale.
• Conduent: Conduent provides healthcare utilization management, claims processing, and clinical review services to government and commercial clients, with overlapping capabilities to AMR in the UM and IRO space.
• AIM Specialty Health: AIM Specialty Health, part of Elevance/Carelon, provides specialty utilization management and clinical review services to health plans - competing with AMR in the payer utilization management segment at significantly larger scale.
• MultiPlan: MultiPlan is a cost-containment and independent review organization serving payers, TPAs, and employers with peer review, utilization management, and bill review services - broadly comparable to AMR's payer-focused offering.
• eviCore Healthcare (Evernorth/Cigna): eviCore is a large-scale utilization management and specialty benefits management platform within Evernorth/Cigna, offering peer review and medical necessity determination capabilities across payer and provider markets - overlapping AMR's UM services at greater scale.

Direct peers

• Dane Street: Dane Street delivers independent medical examinations, peer reviews, and utilization management services for the workers' compensation and group health markets, directly overlapping AMR's workers' comp and payer segments.
• AllMed Healthcare Management: AllMed provides independent medical peer review and utilization management services for health plans, TPAs, and managed care organizations, competing head-to-head with AMR in the same IRO market.
• MES Solutions: MES Solutions provides independent medical peer reviews, IMEs, and utilization management services to insurance carriers, TPAs, and government entities - a direct competitor in the IRO space.
• MCMC: MCMC is an independent review organization providing medical peer review, utilization management, and independent medical examination services to payers and government clients - directly comparable to AMR's core IRO offering.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/advanced-medical-reviews
• Xx.com/amr_reviews
• Facebookfacebook.com/advancedmedicalreviews

Compliance6 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles8 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Advanced Medical Reviews