ProPeer Resources, a leading independent review organization specializing in utilization management and peer review services, today announced it has earned a three-year Utilization Management (UM) Accreditation from the National Committee for Quality Assurance (NCQA), one of the most respected independent validators of quality in healthcare. NCQA Utilization Management Accreditation is a quality assessment program that focuses on consumer protection and customer service improvement.

This accreditation recognizes ProPeer’s commitment to delivering rigorous, consistent, and evidence-based utilization management processes that support appropriate care decisions while maintaining compliance with evolving regulatory and industry standards.

“Achieving NCQA Utilization Management Accreditation is an important milestone for ProPeer and for the clients who rely on us to deliver clinically sound, compliant, and defensible review services,” said Ed Bolton, President and CEO. “This accreditation is ultimately about trust. Our clients depend on us to deliver objective, physician-led reviews that stand up to scrutiny. NCQA accreditation confirms that ProPeer’s processes, controls, and clinical oversight meet one of the highest standards in healthcare quality.”

NCQA Utilization Management Accreditation evaluates performance across key areas including quality improvement processes, client collaboration, member confidentiality, involvement of qualified clinical professionals, fair and timely decision-making, appeals handling, and measurement of member and provider experience.

A Meaningful Validation for Clients

By meeting these standards, ProPeer demonstrates that its utilization management program operates with transparency, clinical rigor, and accountability, providing clients with confidence that reviews are conducted according to nationally recognized best practices.

“Achieving NCQA Utilization Management Accreditation reflects a rigorous commitment to applying fair, timely, and evidence‑based criteria in utilization review. It signifies ProPeer Resources sustained investment in the systems, governance structures, and clinical expertise required to uphold the highest quality standards and advance the appropriateness and effectiveness of care for the populations it serves,” said Dr. Vivek K. Garb, President and CEO, NCQA.

The accreditation strengthens ProPeer’s established compliance framework and further differentiates the organization by validating its operational maturity, physician-led clinical review model, and commitment to quality-driven outcomes for health plans, TPAs, employers, and workers’ compensation organizations nationwide.

By embedding accredited utilization management practices into its peer review model, ProPeer continues to advance its mission of simplifying complex clinical review programs while ensuring decisions remain clinically appropriate, timely, and defensible.

NCQA has reviewed and accredited ProPeer Resources’ Utilization Management functions only. For complete details on the scope of this review, visit www.ncqa.org.

About ProPeer Resources

ProPeer Resources is an independent review organization providing utilization management, peer review, and clinical review services to health plans, third-party administrators, employers, and workers’ compensation organizations nationwide. ProPeer combines physician-led clinical expertise, operational rigor, and advanced workflow processes to deliver timely, objective, and high-quality review outcomes. Learn more at www.propeer.com.

About NCQA

NCQA is an independent nonprofit organization that defines and drives health care quality through accreditation, standards, performance measurement, and expert support. For more than 35 years, NCQA has advanced transparency, accountability, and enabled healthcare organizations to deliver better outcomes for patients. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is one of health care’s most widely used performance improvement tools. Learn more at ncqa.org. Follow NCQA on X @ncqa and on LinkedIn linkedin.com/company/ncqa.

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