Utilization Review – Workers’ Compensation

Patriot Care Management’s (PCMI) experienced registered nurses review medical treatment requests using national evidence based clinical criteria, or a State’s own treatment guidelines to validate medical necessity and appropriateness of a treatment plan.

Utilization Review may include prospective, concurrent or retrospective reviews. A registered nurse completes a first level review and refers to a second level review (IRO) when applicable. The key aspects of PCMI’s UR program are:

  • Medical cost containment.
  • Acceleration and improvement in decision-making.
  • Delivery of appropriate care for injured workers.
  • URAC accredited for workers compensation Utilization Management.
  • Certified by several states for Utilization Review and compliance with state regulations.
  • Software integration ability with case management, bill review, internal review organizations (IRO), and pharmacy benefit programs.
  • Supplement the Case Management Process.

To complement the Utilization Review process, PCMI’s UR nurses use proprietary software, DecisionUR™. This software provides end-to-end web based utilization review capabilities. DecisionUR™ software was first in the market to automate initial reviews and to auto transmit peer reviews to the appropriate IRO. The software is a secure, scalable and highly configurable solution that supports a wide variety of business processes.

 

Contact information:

By Telephone: Toll-Free (877) 323-9903, option 6
In Writing: Patriot Care Management, Inc. Attention: UR Department, Rosalie Opalka; PO Box 2159; Fort Lauderdale, FL 33303
Via Facsimile: 1-866-559-1838
Via Electronic mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
Via Contact Form: Contact Us

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