Utilization Management: Expert Guidance Leading to Optimal Outcomes
Our Utilization Review Program evaluates the medical necessity, appropriateness, and efficacy of any medical services, procedures, medications, or practitioner specialties as referred by clients. The goal of the program is to provide clients with medical necessity recommendations that are supported by current evidence-based medicine and that promote positive patient outcomes.
The Value of Utilization Review
- Utilizes nationally recognized, evidence-based guidelines, to review the provider’s treatment plan and determine if treatment is appropriate for the injured worker’s condition
- Ensuring injured workers receive appropriate and medically necessary care, facilitating a better recovery
- Control unnecessary medical treatment and associated costs that could extend an injured worker’s recovery and return to work
- The workers’ compensation insurer always has the final authority on payment approval or denial of a medical service