Physician Advisor and Peer Review
Leverage Evidence-Based Guidelines to Address Case-Specific Questions
Leverage Evidence-Based Guidelines to Address Case-Specific Questions
Genex’s Physician Advisor Services address specific questions about preauthorization, medical treatment plans, disability durations, ability to return to work, pre-existing medical conditions, and causality of the condition.
Medical file review
We will provide a thorough retrospective and current review of a practitioner’s medical treatment plan to determine the medical necessity and appropriateness of the treatment rendered. Our consulting physicians are readily available for depositions and testimony, and will provide comprehensive reports that include recommendations regarding both past and future medical treatment. If a provider questions issues of medical necessity and high-dollar reductions, our local networks of physician consultants are able to appropriately re-evaluate bill review determinations. The development of local, professional medical claims support means additional savings for you.
Utilization review and medical necessity review
On a national level, Genex physician resources determine the necessity and appropriateness of utilization review requests at the initial or appeal stage.
Physician advisor consultation
For instances when questions arise about the treatment plan or current diagnosis, there is an opportunity for a phone conversation between the case manager and/or adjuster and the clinical reviewer. Additionally, we offer an opportunity for a phone conversation between the treating provider and the peer clinical reviewer for instances when the claimant has been out of work longer than optimum disability duration, the provider refuses to release the medical information to the case manager, conflicting medical information is received, and the provider refuses to address causal relation when co-morbidities exist.
Need to Reduce Your Total Cost of Risk?
To help lower your total cost of risk and return injured workers to work as quickly as possible, we offer a FREE consultation with a workers’ comp expert. Together, we will begin to build a workers' comp program to meet your company’s unique needs.
