ACP Prime

Unbiased & Expedient Peer Reviews

Why ACP PRIME?

Peer or Physician Reviews are a well-known required component of a formal Utilization Review program.  But did you know that Peer Reviews can be extremely helpful at specific points in a claim?  A thorough, focused Peer Review can provide the adjuster with a physician’s evaluation on all or a more limited set of medical records to address injury causality and more. The Peer Review is a strategic tool that can be ordered in any jurisdiction as they are not considered a part of a formal Utilization Review process or program.  

When to Order ACP Prime

  • Address causality and/or medical necessity of treatment prior to claim settlement discussions
  • Determine injury causality to a body part an injured worker or attorney is requesting be added post claim examination.
  • Evaluate long term use of narcotic medications. Peer-to-Peer discussion can be requested to obtain treating provider agreement to weaning protocols.
  • Document discussions with ACP’s medical director during Grand Rounds
  • In jurisdictions such as FL, determine what an IME may indicate and receive guidance when IME should be considered.
  • Obtain appropriate questions for an IME

Real Results

Peer reviews are a helpful tool to address questions of injury relatedness and causality.  Recently, an Injured Worker’s (IW) claim was discussed at Grand Rounds with ACP’s Medical Director, Dr. Avrom Gart.  Dr. Gart had previously reviewed the associated medical reports and documentation submitted by the Case Manager on the claim.  During the Grand Round’s discussion, Dr. Gart pointed out that the injured worker’s back symptoms were caused by the IW’s pre-existing and genetic conditions and not by the injury described.

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Real Results

Peer reviews are a helpful tool to address questions of injury relatedness and causality.  Recently, an Injured Worker’s (IW) claim was discussed at Grand Rounds with ACP’s Medical Director, Dr. Avrom Gart.  Dr. Gart had previously reviewed the associated medical reports and documentation submitted by the Case Manager on the claim.  During the Grand Round’s discussion, Dr. Gart pointed out that the injured worker’s back symptoms were caused by the IW’s pre-existing and genetic conditions and not by the injury described.

The adjuster requested a peer review be completed to formally document the Medical Director’s review. The completed Peer Review report that outlined the lack of causality for the back injury was sent to the Adjuster who was preparing for settlement.  The Adjuster was able to use the Peer Review report as the basis to dispute the back as a covered body part to the claim.   

The Adjuster agrees that without the Peer Review discussion of causality issues and the subsequent formal report,  the costs to settle the claim would be significantly higher.  

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