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 E/F Key Benefits
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Proactive approach to medical treatment
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Answers compensability questions
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Decreases claims cost
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24-48 hour turn around time on reviews
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Utilization Management provides a review of procedures and treatments to determine medical necessity and/or work-relatedness. Our registered nurses and physicians utilize nationally recognized protocols, alleviating unnecessary medical costs and assisting our clients in saving valuable claims dollars.
The following components are available:
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Precertification/Preauthorization — reviewing information prior to inpatient admission, or selected outpatient treatments or services, to determine medical necessity of the proposed treatment or admission.
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File Review and Bill Audit — Experienced registered nurses review the claimant's medical records to ensure compliance with the worker’s compensation, liability, or other pertinent billing criteria for each state. The bills are then reviewed for relatedness and to ensure all charges are supported in the medical record.
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