GENEX California Utilization Review

Solutions and Services

GENEX is accredited for all UM sites by URAC in Workers’ Compensation Utilization Management. This demonstrates our commitment to service quality and accountability.  It guarantees that we have policies and procedures in practice that meet and typically exceed industry standards.  It assures compliance with State and Federal laws and Managed Care Regulations.

GENEX is registered with the California Division of Workers' Compensation and meets and exceeds all state requirements. 

GENEX Utilization Review service delivers superior customer service and a high-quality program.  GENEX is flexible and will partner with our clients to customize a utilization review product that meets your needs.

Solutions:

• Fully Integrated with GENEX Medical Review Services
• Strict compliance with state jurisdictional requirements and guidelines
• Physician advisor review as needed including peer-to-peer clinical discussion with providers prior to any non-approval decision
• GENEX provides a Nurse appeals coordinator that is available to assist with request for appeals, demand letters and preparation for expedited hearings
• Secured client access via web to our Case Management System via GENEX Case Connect.   
• Peer Review provides direction and recommendations on files in the process of settlement
• GENEX provides reports for cost analysis, ROI and to identify trends

 Services:

• Prospective review
• Retrospective review
• Concurrent review
• Second Surgical Opinion
• Pharmacy Review
• Peer Review