ezURs.com accredited and state-certified Utilization Review service provides prospective, concurrent and retrospective review of the medical necessity of services requested. prospective, concurrent and retrospective review of the medical necessity of services requested.
Our utilization review services facilitate the timely and appropriate treatment of injured employees while providing employers with greater financial controls.
Registered nurses complete first level reviews based on national, evidence-based guidelines, and coordinate reviews with our expert Physician Advisors when such guidelines are exceeded or unmet. Registered nurses perform both Utilization Review and Telephonic Case Management as regulations permit, providing a seamless and efficient process to facilitate timely and appropriate treatment.
To help employers more effectively manage their costs, we offer both integrated and boutique utilization review services. All of our utilization review programs are customized according to state and employer specifications. Utilization review services are provided by our staff of highly skilled, licensed clinicians using state-mandated guidelines and nationally recognized treatment guidelines.
Components of our utilization review program include:
- Prospective review
- Concurrent review
- Retrospective review
- Pharmacy/drug utilization review
- Clinical peer review (physician advisor/peer-to-peer review services)
Integrated and boutique utilization review services
Outcomes
Our experienced utilization management staff can reduce over utilization, streamline the coordination of care and control costs while ensuring quality care. Quick review and well documented synopsis of decision helps speed injured workers’ access to treatment, get the injured worker back to work and saves payors from unnecessary expenditures. Our experts can participate in a well-defined dispute resolution process and provide all supporting documentation for care.
Cost Savings
To achieve cost savings, we take measures to ensure that its clients are in the best position available. We work with PBMs to assist in obtaining the lowest pharmacy cost in the industry. We have custom reporting to identify over-utilization, unsafe prescribing procedures, and opportunities for reductions in medication costs. With our Medical Directors and a nationally-accredited peer review panel for peer and specialty reviews we ensure that the cost savings do not come at the expense of quality of care.
Peer Panel
ezURs has a large panel of over 1000 physicians nationwide. Our board certified, active practice reviewers are available and accessible for rush cases. Our network of specialty physicians combine to bring you decades of extensive knowledge in various healthcare benefit plans, state workers compensation plans and industry standard guidelines such as ACOEM & ODG. All of our peer reviews are managed by health professionals in distinguished specialties to provide exceptional, independent medical direction and guidance.
Independent Medical Examination
Arranged with board certified physicians whose field of expertise is related to the claim diagnosis . Comprehensive reports are provided, communicating medical recommendations and work status to assist in expediting a claim to full recovery or settlement direction and guidance.
