Preauthorization / Pre-certification Services
The Review Med panel includes highly respected medical professionals who maintain active clinical practices in addition to providing peer reviews and expert testimony. Preauthorization/Precertification Service is a cost containment tool that requires health care providers to request and receive approval from the insurance carrier for certain medical services prior to the delivery of those services. This is done in accordance with individual state mandated medical treatment guidelines using evidence based, nationally recognized scientific guidelines, as appropriate.
Concurrent / Continued Stay Review
As part of Review Med’s utilization management program, health care is reviewed as it is provided. Reviewers monitor appropriateness of the care, the setting and the progress of discharge plans. The ongoing review is directed at keeping cost as low as possible and maintaining effectiveness of care.
Review Med offers a retrospective review for a single date of service or for the purposes of Bill Review to determine medical necessity of procedures, admissions and services that were not certified prior to or during the occurrence. Refer to the Peer Review/Medical Record Review for a medical retrospective review for multiple services/providers.
Review Med handles several different levels of appeals which include a reconsideration, expedited, standard, and state level appeals. These appeals are handled by an appropriate physician advisor of the same profession or similar specialty. They typically manage the same type of medical condition, procedure, or treatment and have not previously reviewed the clinical information.