Recent legislation in California, Texas and other states, has increased the impact that utilization review can have on your bottom line. Definiti’s UR program is based on the following guidelines. The success of our program is initiated by licensed clinical professionals and effective and efficient communication among all parties immediately involved in the claim.
Our Utilization Review service provides:
- Review prospective, concurrent and retrospective requests for treatment for medical necessity and appropriateness
- Turnaround times exceed state mandated time frames if applicable
- Nurses work closely with adjusters to ensure that requested treatment does not conflict with the planned direction of the claim. Issues such as denied body parts, ongoing investigation, and litigation are discussed prior to review
- Link telephonic and UR management with bill review software
- All reviews are based on ACOEM, ODG and other nationally recognized medical guidelines
- Our Medical Director has extensive knowledge of Workers’ Compensation medical issues
