URNow Utilization Review Services confirms the
medical necessity and appropriateness of the treatment plan. Our
process is initiated upon receipt of an intake form for approval of
a service or procedure from the treating provider or facility
rendering service.
Conducting the initial clinical review, a certified nurse reviewer
determines if the suggested treatment plan is medically necessary
and appropriate. For cases that demonstrate medical appropriateness
based on clinical review criteria, our Nurse
Reviewer recommends certification of the proposed treatment plan and issues an authorization. If the treatment plan is not supported by the clinical information provided, the case is referred for Peer Clinical Review. Only a Peer Clinical Reviewer/Physician Advisor can render a non-certification recommendation. Our Nurse
Reviewers use established utilization review process
standards, assuring our clients receive the highest degree of
professional medical accuracy.
proactive approach to managing the ongoing health care of the injured person or review of any injury, treatment, equipment and medications.
appropriateness of all medical treatment plans through peer review and Identify treatment considered excessive or experimental.
Our utilization review helps reduce medical costs by managing length of treatment and detecting potentially high cost cases at an earlier stage.
