External peer review companies for hospitals
Short version: hospitals send a case outside when no one on staff can review it without a conflict, when internal reviewers disagree, or when litigation or a privileging decision is likely. For most of those cases, shortlist Quality Peer Solutions, MRN or NPRC; for cardiovascular, neuroscience or orthopedic programs add Corazon; for rural hospitals and FQHCs add Medplace.
Limits: Firm facts come from each firm's own website, read 2026-11-12; we haven't hired these firms or graded their reports, and "not stated" means we didn't find it, not that the firm doesn't do it.
When a hospital sends a peer review case outside
External review is the exception, not the routine. A 2017 Credentialing Resource Center piece, republished by HealthLeaders, lists the usual triggers, which the hospital's peer review policy should name in advance:
- Litigation risk. A lawsuit is possible and the hospital wants an opinion from outside its own staff.
- Ambiguity. Internal reviewers or committees reach vague or conflicting conclusions, and the outcome will affect the physician's membership or privileges.
- No qualified peer on staff. No one has the expertise, or the only physicians who do compete with or work closely with the physician under review.
- Other needs. An expert for a fair hearing, review of a credentials file, or a benchmark for quality monitoring.
The same piece notes that the MEC or the board decides whether to go outside, and that a physician can't force the hospital to obtain an external review. Write that into the policy before the first contested case, not during it.
FPPE, OPPE and focused case review: what you're asking the firm for
| Review type | What it is | What to ask the firm for |
|---|---|---|
| FPPE (focused professional practice evaluation) | A time-limited evaluation, used for new privileges or when a concern is raised about a practitioner. | A reviewer in the same specialty and practice setting, scored on criteria your medical staff set in advance. |
| OPPE (ongoing professional practice evaluation) | A recurring evaluation of every privileged practitioner against set indicators. | Help designing the form (MRN offers this), then reviewers who can score a batch of cases the same way each cycle. |
| Focused case review | 1 case, 1 question: was the care within the standard? | A written report that answers the committee's questions, delivered before the committee meets. |
| Department or program review | A look at a whole service line or a hospitalist program. | A firm that does program work: NPRC, Corazon, Chartis or Coker. |
| Conduct review | Disruptive behavior or professionalism, not clinical care. | NPRC lists disruptive provider review; most other firms don't. |
Definitions follow the firms' own descriptions (MRN, NPRC, Quality Peer Solutions), captured 2026-11-12.
The 10 hospital peer review firms, side by side
| Firm | Specialty scope | What it says about reviewers | Turnaround stated | Worth knowing | Source, captured |
|---|---|---|---|---|---|
| ARCHI rural physician peer review | Like-specialty panels | Peers from participating facilities; CME credit per meeting | Monthly meetings or a direct review track | An internal, case-based model rather than an outside firm; listed because small hospitals use it instead of 1. | architexas.org/programs/physician-peer-review/index.html, 2026-11-12 |
| Chartis (with Greeley) | Specialty physicians per program | Physician-led | Not stated | Redesigns and assesses peer review programs; external peer review is offered alongside. | chartis.com/expertise/peer-review, chartis.com/insights/beneficial-not-burdensome-guide-external-peer-review, 2026-11-12 |
| CIMRO | 100+ specialties | Peer reviewer matched on specialty and practice setting | Not stated | Says it has done peer review since 1972 with a network of over 500 reviewers. | cimro.com, 2026-11-12 |
| Coker (NorthGauge Healthcare Advisors) | All specialties and subspecialties | Physician peers matched to the case; evidence-based criteria | Not stated | Peer review sits inside a consulting firm; physician panel runs under NorthGauge. | cokergroup.com/individual-services/physician-external-peer-review-consulting, 2026-11-12 |
| Corazon | Cardiovascular, neuroscience, orthopedics only | Practicing physician advisors in those 3 service lines | Not stated | Narrow on purpose; also offers proctoring for new procedures. An Ingenovis Health company. | corazoninc.com/services/peer-review, corazoninc.com/external-peer-review-challenges-for-hospitals-and-a-smarter-solution-for-specialty-care, 2026-11-12 |
| Medplace | 132 subspecialties | Practicing, board-certified physicians | 6-day turnaround | Sells reviews and a platform to run your own review program. | medplace.com, medplace.com/peer-review, 2026-11-12 |
| MRN | Matched per case | Board-certified, in active clinical practice, outside MRN; a legal nurse consultant interviews the reviewer and writes the report | Not stated | Nurse consultants pick a reviewer for each case instead of routing to a fixed panel. | medres.net/areas-of-expertise/external-peer-review/external-physician-peer-review-companies, medres.net/areas-of-expertise/external-peer-review/oppe-physician-peer-reviews, 2026-11-12 |
| National Peer Review Corporation (NPRC) | Matched per engagement | Board-certified, experienced in peer review, in active practice; every report also read by NPRC staff and legal counsel | Completion date agreed at engagement | Case review, disruptive provider review, clinical department review and hospitalist program review; says it has run external peer review for more than 40 years. | nationalpeerreview.com, nationalpeerreview.com/external-peer-review-services, 2026-11-12 |
| Peer Review Plus | Cardiology-led advisory board | Qualified physicians from external sites, assigned at random | Not stated | A platform from MedAxiom leaders, still recruiting alpha and beta test sites when we checked. | peerreviewplus.com, 2026-11-12 |
| Quality Peer Solutions | 39 specialties and subspecialties | Board-certified, actively practicing, 2+ years of relevant experience, conflict attestation per case, recredentialed at least every 3 years | Case manager responds within 24 hours; report time not stated | OPPE and FPPE reviews; senior reviewers audit every reviewer each quarter. | qualitypeersolutions.com, 2026-11-12 |
Specialty, credential and turnaround cells repeat each firm's own pages. Board certification, practice status and conflict checks are scored firm by firm on the credentials page.
How an external peer review case moves
What to send, and what should come back
The firm can only review what you send. A thin packet produces a thin report, and a missing nursing note becomes the reviewed physician's best argument. Before the file leaves the building, the quality team should check that it holds:
- the complete encounter, including outside records the physician saw at the time;
- orders with times, medication administration records, vitals and nursing notes for the window in question;
- the committee's written questions, 3 to 5 of them, each answerable from the record;
- the physician's own written response, if your policy allows it;
- the criteria or form you want the reviewer to score against.
Back from the firm you should get a report that answers each question, cites the record for each finding, names the reviewer's specialty and board status, and includes the reviewer's conflict statement. If your state's peer review privilege depends on how the report is labeled or routed, the firm should follow your labeling. MRN says its reports are prepared to stay protected under state peer review statutes.
Picks for hospitals, with the catch
- General FPPE and focused case review: Quality Peer Solutions states the most about its reviewers of any peer review firm we read (board-certified, active practice, 2+ years of relevant experience, per-case conflict attestation, recredentialing at least every 3 years). Catch: no report turnaround published, only a 24-hour case manager response.
- Cases that need a carefully chosen reviewer: MRN has nurse consultants pick a reviewer per case rather than routing to a standing panel, and has a nurse write the report from the physician's findings. Catch: no turnaround or coverage stated.
- Conduct, department and fair hearing work: NPRC lists all 3, and legal counsel reads every report. Catch: the site footer runs to 2023, so confirm current capacity.
- Heart, brain and bone programs: Corazon. Catch: nothing outside those lines.
- Small, rural and FQHC buyers: Medplace, with a stated 6-day turnaround and 132 subspecialties. Catch: it also sells a platform; be clear whether you're buying reviews, software or both.
Questions hospitals ask about external peer review firms
How many external peer review companies serve hospitals?
Our directory lists 10 firms whose own pages describe hospital peer review, captured 2026-11-12. UR and IRO firms such as MLS and CIMRO also take hospital work, mostly physician advisor and appeal cases.
Do external peer review firms need URAC accreditation?
Not for hospital peer review as far as the firms' pages show: only CIMRO among the 10 states URAC accreditation. URAC matters for utilization review and external appeals, where many payer contracts and state rules ask for it.
Who writes the external peer review report?
Usually the reviewing physician. Some firms split the work: at MRN a legal nurse consultant interviews the physician reviewer and writes the report from those findings; at NPRC staff and legal counsel read each report before release.
How long does an external peer review take?
Medplace states 6 days. NPRC agrees a completion date at the start of each engagement. The other peer review firms don't publish a number, so get a date in writing before you send the packet.