Medical review services are performed prospectively and retrospectively when a medical service or claim requires review for appropriateness.
We utilize a panel of specialized physicians who evaluate recommended treatments or services to assess appropriateness and medical necessity of treatment. This team provides clinical and analytical expertise for a wide variety of claim management and medical management programs. These services can be utilized to determine if a treatment is experimental or investigational, if coding is accurate and charges are appropriate, off-label usage of medications, standard of care and many other types of treatment or claim questions.
Physician Review Services (PRS) is a valuable resource for securing clinical expertise in claim management and medical case management. Our diverse panel of specialized, experienced physician reviewers provides well-reasoned and carefully- documented determinations that evaluate the medical necessity of medical services, support timely return to work and assess the extent of functional impairment.