CompAlliance Workers’ Compensation Utilization Review with Physician Advisement is employed when there is a question as to the medical necessity of the type or length of treatment being recommended. This physician review helps to speed a decision by the employer or carrier and ultimately the recovering worker, who receives a decision regarding the treatment that is appropriate for their condition.

CompAlliance offers a team of Physician Reviewers that provide cost-effective, and unbiased medical reviews. We use physician expertise to determine medical necessity and appropriateness of care. Evidence based guidelines supporting the physician opinions are included with each report. Types of Review include:

  • Prospective Review – pre-certification
  • Concurrent Review – during episode of care
  • Retrospective Review – after charges are billed
  • Peer Review, if mandated by state laws
  • Pre-Admission and Continued Stay Review

 

CompAlliance UR Plan

 

Additional resources regarding Utilization Review and its application in workers’ compensation and healthcare

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