Workers’ Compensation Utilization Management with potential need for Utilization Review at its basic level is a very simple process; does the treatment request match established and/ or accepted peer reviewed medical guidelines?  What sets one vendor apart from the other is the philosophy with which they approach the function of Utilization Management and Utilization Review:

  • Do their Nurses and Physicians collaborate and negotiate with treating physicians to develop a treatment plan that is the most appropriate for the recovering worker, or do they evaluate each treatment request in a vacuum?
  • Do they offer to utilize different strategies to help clients manage their costs and stay in-line with regulatory requirements?
  • Do they come from a perspective that they need to deny care to show a savings? Or do they see the bigger picture and understand that prompt treatment will lead to better outcomes for the recovering worker and employer in the long-run?

CompAlliance’s Utilization Review program has shown outstanding results and great satisfaction for all our clients. CompAlliance saves you money on the cost of UR services while reducing your medical expenses and minimizing your exposure to penalties through a collaborative approach to Utilization Review and/or Utilization Management. We are excited to announce our successful URAC re-accreditation to September 1, 2021.

The CompAlliance approach not only saves our clients money on the cost of review services, it also prevents unnecessary treatment without putting an emphasis on denials.  Our approach builds a more cooperative relationship with treating providers and expedites treatment.  A medically appropriate return to work is facilitated, along with timely Maximum Medical Improvement. For more information about the UM process contact UM info.