P&S Network

What P&S Network does

P&S Network, operating as Physicians and Surgeons Network, Inc., is a URAC-accredited Independent Review Organization (IRO) and Workers' Compensation Utilization Management Organization headquartered in Beverly Hills, California. Founded in 2003, the company provides conflict-free specialty-matched peer reviews, utilization management determinations, pharmacy and medication reviews, impairment ratings, and OIG-approved CIA/IA audits of Medicare and Medicaid claims. Service delivery is anchored by a panel of 65+ board-certified, active-practice physicians across 20+ specialties, with oversight from National Medical Director Avrom Gart, MD, who has held the role since 2004. The company reports over 1 million reviews performed since inception and maintains 100% compliance ratings alongside dual URAC accreditations valid through 2027.

The company runs a custom technology stack consisting of the Smart Utilization Review Flow (SURF), a workflow platform that tracks requests from RFA submissions through peer review determinations, and the API Management Platform (AMP), a secure integration layer built on Amazon Web Services. These systems underpin HIPAA-compliant operations and are positioned as integrated, end-to-end tooling rather than piecemeal vendor services. Operations are US-based, with credentialed physicians, physician assistants, and registered nurses serving clients nationwide across all US time zones.

P&S Network sells primarily to enterprise B2B customers — TPAs, insurance carriers, pharmacy benefit plans, managed care organizations, and self-insured employers — via a direct enterprise sales motion and a contact-form-driven engagement with Solution Specialists. Services are customized to each client's requirements and quoted individually rather than published; the firm emphasizes next-day turnaround with same-day stat reporting on an as-needed basis. Revenue is generated on a per-service or per-determination professional services fee basis. The privately held company reports no parent company, external funding, or M&A activity.

Name

P&S Network

Legal name

Physicians and Surgeons Network, Inc.

Website

https://pandsnetwork.com

Company type

Private

Founded year

2003

Operating status

Operating

Headcount range

11–50 employees

Short description

P&S Network is a URAC-accredited Independent Review Organization and Workers' Compensation Utilization Management Organization founded in 2003, delivering specialty-matched peer reviews, utilization management, pharmacy reviews, and Medicare/Medicaid CIA/IA audits to TPAs, insurance carriers, pharmacy benefit plans, managed care organizations, and employers across the United States.

Ownership category

akta.pro rank

Product category

Independent Medical Review and Utilization Management Services

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Hospital & Medical Service Plans (6324)

akta.pro industry

PRIMARYHLALADAI

Second Opinion & Expert Medical Review Platforms

Healthcare & Life Sciences/Telehealth Platforms/Employer-Sponsored Virtual Care Platforms

Keywords

• Independent medical reviews
• Peer review services
• Utilization management
• Workers compensation reviews
• Pharmacy peer reviews

Headquarters

HQ city

Beverly Hills

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, Infrastructure, Marketing or Sales

Revenue model

1. Peer Review Services: Independent medical peer review services performed by specialty-matched board-certified physicians. Services include Independent Medical Reviews (IRO), Workers Compensation UR Determinations, Pharmacy and Medications Peer Reviews, and Impairment Ratings. Revenue is generated through per-service fees for medical review determinations.
2. Utilization Management Services: Customizable Utilization Management solutions including Level I and Level II UR Determinations. Revenue generated through service fees for healthcare professionals evaluating medical necessity following ODG, ACOEM, and state-specific guidelines.
3. CIA/IA IRO Audits: Comprehensive reviews of claims submitted to Medicare and Medicaid programs, determining medical necessity, documentation accuracy, and correct coding/billing/reimbursement. Revenue from audit and review service fees.

Go-to-market motion1 record

Distribution channels1 record

Marketing channels3 records

Core offering

P&S Network provides independent medical, pharmacy, and workers' compensation peer review and utilization management services delivered by a panel of 65+ US-based, credentialed board-certified physicians, physician assistants, and registered nurses. The services span Independent Medical Reviews (IRO), Workers' Compensation UR Determinations (Levels I and II), Pharmacy and Medications Peer Reviews, CIA/IA IRO Audits, and Impairment Ratings, all supported by proprietary technology platforms (SURF and AMP) on AWS cloud infrastructure.

Product overview

P&S Network offers a portfolio of healthcare peer review and utilization management services, underpinned by two core technology products: Smart Utilization Review Flow (SURF) for end-to-end request tracking and compliance management, and the API Management Platform (AMP) for secure data exchange. Their service offerings include Independent Medical Reviews (IRO), Workers Compensation UR Determinations at Level I and Level II, Pharmacy and Medications Peer Reviews, CIA/IA IRO Audits, and Impairment Ratings—all overseen by board-certified physicians and delivered by credentialed US-based healthcare professionals.

Differentiator

Problem solved

Functional benefit

Products and services

• Independent Medical Reviews (IRO) IRO services performed by specialty-matched, board-certified physicians to resolve medical treatment disputes without unnecessary repetitive appeals. Aimed at TPAs, insurance carriers, managed care organizations, and government programs needing conflict-free medical determinations.
• Workers Compensation UR Determinations (Level I) Highly customizable and cost-effective Utilization Management solutions in which healthcare professionals interact with requesting physicians and claimants to evaluate medical necessity following ODG, ACOEM, and state-specific guidelines. Targeted at TPAs, insurance carriers, and employers managing workers' compensation claims.
• Workers Compensation UR Determinations Peer Reviews (Level II) High-quality peer reviews performed by specialty-matched physicians at competitive prices with next-day turnaround (and same-day stat reporting available). Offered since 2003 to support workers' compensation utilization management workflows.
• Pharmacy and Medications Peer Reviews Peer reviews to ensure the safe and cost-effective use of medications, including assistance in discontinuing patients from risky opioid/narcotic levels and substituting generics for expensive brand-name drugs. Designed for pharmacy benefit plans, managed care organizations, and workers' compensation payers.
• CIA/IA IRO Audits Comprehensive reviews/auditing of claims submitted to Medicare and Medicaid programs to determine medical necessity, proper documentation, correct coding, billing, and reimbursement compliance. Conducted under the company's OIG-approved IRO status for government healthcare program integrity.
• Impairment Ratings Independent Impairment Ratings performed by certified specialists, giving claims examiners the ability to challenge original ratings through deposition or other means. Aimed at workers' compensation payers, TPAs, and attorneys handling injury claim settlements.

Quantifiable outcome

• 1M+ reviews performed
• +2 more outcomes

Named customers6 records

Segments6 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature2 records

Partnerships

Two partnerships are on record, tiered core.

• URACcoreOthersURAC provides accreditation for Independent Review Organizations and Workers' Compensation Utilization Management Organizations. P&S Network holds dual URAC accreditation (IRO WUM010028 and IRC010012), demonstrating compliance with rigorous quality standards in healthcare utilization management and independent medical reviews.
• Office of Inspector General (OIG)coreOthersOIG approval enables P&S Network to conduct comprehensive reviews of claims submitted to Medicare and Medicaid programs as part of CIA/IA audits, determining medical necessity and proper reimbursement.

Scale indicators5 records

Recent moves6 records

Expansion highlights4 records

Broad incumbents

• eviCore healthcare: Large-scale utilization management and specialty benefits management provider owned by Evernorth (Cigna). Overlaps with P&S's UR determinations and pharmacy peer review but operates at significantly greater scale across medical and pharmacy benefit management.
• AIM Specialty Health: Specialty health utilization management subsidiary of Elevance Health. Provides utilization review and clinical appropriateness solutions comparable in scope to P&S's UR determinations but at much larger scale and integrated within a major payer.
• HealthHelp: Specialty benefits management company offering utilization management and peer review services to health plans. Adjacent competitor in prior authorization and peer review workflows analogous to P&S's IRO offerings.
• MCG (formerly Milliman Care Guidelines): Evidence-based clinical decision support and care guidelines vendor serving payers and providers. Comparable to P&S in driving UR determinations, but as a guidelines/analytics platform rather than a peer review organization.

Direct peers

• Genex Services (Mitchell/Enlyte): National workers' compensation utilization management and peer review provider. Direct competitor in WC UR determinations, case management, and pharmacy peer review for comp claims.
• Dane Street: Provider of independent medical examinations, peer reviews, and utilization management for the workers' compensation and insurance markets. Competes head-to-head with P&S in WC peer review and impairment ratings.
• Medical Review Institute of America (MRIA): Independent peer review organization providing specialty-matched physician reviews for payers and providers. Closely mirrors P&S's conflict-free IRO value proposition and enterprise client base.
• AllMed Healthcare Management: Independent peer review and utilization management company serving health plans, TPAs, and MCOs. Directly comparable to P&S's IRO and UR determinations offerings with similar enterprise B2B motion.
• MCMC LLC (Medical Consultants Management Company): Independent medical peer review and utilization management organization serving payers, TPAs, and MCOs. Closest direct competitor to P&S Network's IRO and WC UR services with similar specialty-matched physician panel model.

Emerging players

• Permedion: Independent review organization performing Medicare/Medicaid review and quality-of-care audits. Directly comparable to P&S's CIA/IA IRO audits and OIG-approved review work, though smaller in scale.

Market position

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/p-s-network-inc

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

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 P&S Network