Retrospective Review Purpose: Confidential second opinion to help guide the Claims Adjuster or Nurse Case Manager on most appropriate next steps after treatment has been rendered Scope: Plan of care (past and present) Medical necessity Reasonableness Causal relatedness Not limited in scope for questions Reviewer: Unless otherwise stipulated by the customer, the reviewer will be in active practice and disciplined-matched (MD, DO, DC) to the treatment provider Inputs: Medical records (no limit) Evidence Based Medicine Reviewer’s active clinical and academic experience Latest medical research Jurisdictional guidelines Discussion: None with the treatment provider