The HealthCare Industry Back Offfice

Utilization Review

Opportunities:

  • Manipulation treatment, Chiropractic
  • Physical therapy, Occupational therapy
  • Acupuncture
  • Diagnostic testing [MRI]
  • Durable Medical Equipment [DME]
  • Injections [ESI/Nerve Block]
  • Inpatient and outpatient surgery
  • Discharge planning needs [SNF, home health, transportation etc.]

Other Services:

  • Line‐by‐line bill audit
  • Line‐by‐line EOP audit
  • Comprehensive medical chronology
  • Data profiling
  • Coding validation
  • Drug review assignments

Reports Typically Include:

  • Date of Review
  • Level of Review
  • Patient Name
  • Date of Birth
  • Date of Injury
  • Diagnosis
  • Surgery Requested Treatments
  • Determinations
  • Medical chronology and medical record review
  • Medical record summary
  • Rationale for Determinations
  • Per below referenced medical evidence
  • Additional information by client request