These clinical reviews are conducted in parallel with treatment of the injured worker and are focused on validating that appropriate care is being rendered according to the nature of the injury and to return the injured worker to health and work as quickly and completely as possible.

• Concurrent Review
  Work with the treating physician or therapist to develop an agreed upon treatment plan based upon actual medical necessity
• Retrospective Review
  Confidential second opinion to help guide the Claims Adjuster or Nurse Case Manager on most appropriate next steps after treatment has been rendered
• Return to Work
  Establish timeframe and criterion for bringing the patient to maximum work capacity, reduce indemnity cost, allow a more complete convalescence of the patient, and reduce the Claims Adjuster’s workload
• Surgical Coding Review
  Identify up-coding, unbundling, and misuse of CPT codes and provide a basis to approve reimbursement for medical bills without over-payment
• Consultation
  Provide to a Claims Adjuster or Nurse Case Manager direct access via either e-Mail or phone to a clinician (MD, DO, DC) for clinical questions or guidance