Utilization Review and Peer Review Services
Accelerate recovery through prompt, reasonable and necessary care
Simplify the Medical Decision-Making Process
Genex’s Utilization Review Services help accelerate and improve decision-making and delivery of appropriate care for individuals. With results exceeding URAC and/or state requirements, our expedited decisions and treatment scheduling saves administrative time and burden, while ensuring the injured/ill individual gets the care they need as quickly as possible. This easy-to-use process has minimal information requirements for the decision. Services include:
- Prospective review
- Concurrent review
- Retrospective review
- Or peer review as a stand-alone service
Tailored Workflows and Service Delivery Models
Our flexible service delivery models are unique to each client based upon your priorities and goals. Our proprietary utilization review system and automated technology incorporates evidence-based guidelines and applicable jurisdictional rules and seamlessly integrates with case management, bill review, and pharmacy benefit management giving you greater control over care and medical spend across the continuum of care. Our service delivery models include full-service utilization review and peer review, standalone peer review, or overflow to supplement your internal operations.
Regulatory Compliance Focused
Genex has been accredited by URAC in Workers’ Compensation Utilization Management since 1996 and holds an additional accreditation as an Independent Review Organization (IRO). As a national provider of utilization review services, you can rely on Genex’s jurisdictional, workers’ compensation and auto expertise to meet all regulatory requirements.
Peer Review
Genex’s industry-leading peer review program provides clinically sound, defensible reviews, targeting unnecessary medical costs and procedures with input from actively practicing physicians. Our national network of credentialled and licensed physicians cover all specialties and meet all jurisdictional requirements. Physicians are available for both initial and appeal-level reviews.
Learn MoreGenex Services Grievance Process
The Genex grievance process addresses all formal complaints regarding non-clinical and non-determination related Genex processes or services. The grievance process does not address the clinical decision focuses on concerns with the process or people involved in developing the determination. Examples of grievances could be complaints that the utilization review decision was not done within time frames established by the Labor Code or that the physician who rendered the determination was not licensed.
Learn MoreRelated Insights
Need to Streamline your Utilization Review Process?
To accelerate the delivery of optimal care and expedite recovery, we offer a FREE consultation with one of our experts. Together, we will begin to build a customized utilization review program to meet your company’s unique needs.
