Physician Advisor Services address specific questions about preauthorization, medical treatment plans, disability durations, ability to return to work, pre-existing medical conditions, and causality of the condition.
Utilization Review Medical Necessity Review
Medical Necessity Review is a critical component of any utilization review program. On a national level, GENEX physician resources determine the necessity and appropriateness of UR requests at the initial or appeal stage.
Medical File Review
Our Medical File Review service offers retrospective and current review of a practitioner's medical treatment plan to determine the medical necessity and appropriateness of the treatment rendered. Our consulting physicians are readily available for depositions and testimony, and they will provide comprehensive reports that include recommendations regarding both past and future medical treatment.
If a provider questions issues of medical necessity and high dollar reductions, our local networks of physician consultants are able to appropriately re-evaluate bill review determinations. The development of local, professional medical claims support allows us to provide additional savings for our clients.
Physician Advisor Consultation
GENEX offers an opportunity for a phone conversation between the case manager and/or adjuster and the clinical reviewer for instances when questions arise about the treatment plan or current diagnosis.
Additionally, we offer an opportunity for a phone conversation between the treating provider and the peer clinical reviewer for instances when the claimant has been out of work longer than optimum disability duration, the provider refuses to release the medical information to the case manager, conflicting medical information is received, and the provider refuses to address causal relation when co-morbidities exist.