Integrated Utilization Review / Telephonic Case Management

Preferred bundles together Utilization Review and Telephonic Case Management to offer a symbiotic service that insures accuracy and timeliness:

• Claims wherein surgery is anticipated or recommended
• Requests for MRI, CT SCAN, Discogram, Bone Scans, etc.,
• All Cases with Over 14 Days Anticipated Disability
• Chiropractic/Physical Therapy Treatment
• Inconsistent Medical Findings
• Multiple Treating Physicians
• Pre-existing Conditions: Diabetes, Hypertension, Heart Disease
• Patient with History of Drug/Alcohol Abuse
• Continued Treatment by Non-Specialist Beyond 45 Days
• Any unusual claim in which the Claims Examiner feels it may warrant further intervention