Accreditation

Nexus maintains URAC accreditation in Workers’ Compensation Utilization Management. URAC evaluates many factors in granting this accreditation:

• Employs drug utilization management mechanisms to address therapeutic appropriateness, over and underutilization, dosage, duration of treatment, duplication, drug allergies, and more.
• Provides an independent, unbiased determination of medical necessity beginning with an initial clinical review, then moving to a peer clinical review if needed.
• Is prepared to address any risk to patient safety, such as contraindicated treatments, adverse drug interactions, or inappropriate treatment, during the review process.
• Adheres to time frames outlined in the standards for urgent and non-urgent review determinations.
• Understands and adheres to applicable state and federal regulations for Workers’ Compensation programs.

ProPeer, a wholly-owned subsidiary of Nexus, maintains URAC accreditation as an Independent Review Organization: Comprehensive (Internal & External). Factors URAC evaluates for IRO’s Include:

• Is up to date on all federal and state regulations, organizational processes, data security and internal operations.
• Works with appropriately licensed and credentialed peer reviewers who are current on the latest medical standards and technologies.
• Ensures consistency, efficiency and accuracy in internal and external review recommendations.
• Is equipped to deliver three types of utilization review services: retrospective, concurrent, and prospective.
• Provides expertise in experimental and investigational reviews, and are current on the accepted standards of care.
• Has immediate access to physicians and allied healthcare practitioners who are at the vanguard of medical treatments and services.
• Features expansive review panels of hundreds to thousands of experts who can provide access to all recognized specialties and subspecialties.
• Provides advanced, ongoing education and training to ensure the use of reviewers who are knowledgeable about the most current peer-reviewed literature and evidence-based medicine.
• Adheres to standards and guidelines intended to avoid issues of conflict of interest.

Nexus earned the exclusive designation as a Certified Service-Disabled Veteran’s Business Enterprise™ (SDVBE) from the National Veteran-Owned Business Association.

To be eligible for the designation as NaVOBA Certified SDVBE™, the applicant firm must be at least 51% owned, operated and controlled by one or more U.S. military veterans. NaVOBA is an independent 501(c)(3) nonprofit organization led by Corporate Supplier Diversity professionals. It is the mission of NaVOBA to create corporate contracting opportunities for America’s Veteran’s and Service-Disabled Veteran’s Business Enterprises (SDVBEs) through certification, advocacy, outreach, recognition and education. NaVOBA provides a direct link between corporate America and veteran’s business enterprises, to improve business opportunities for SDVBEs of all sizes.

Nexus is certified as a Historically Underutilized Business (HUB) .

The Texas Comptroller of Public Accounts (CPA) has certified Nexus as a Historically Underutilized Business (HUB). The Historically Underutilized Business Program was created to promote full and equal procurement opportunities for small, minority- owned and women-owned businesses.

The definition of a HUB is an entity with its principal place of business in Texas and is at least 51% owned by a minority, woman, or service-disabled veteran-owned business who reside in Texas. The principal must have a proportionate interest and demonstrate active participation in the control, operations and management of the entity’s affairs.