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