Physician ReviewPhysician Review

What Physician Review is, who it's forWhat Physician Review is, who it's for

Concentra Physician Review applies physician expertise to complex or contested workers’ compensation claims.

Our Physician Review services include:

  • The evaluation of medical necessity of the requested treatment
  • Physician-to-physician contact if denial determination is expected
  • A complete written report detailing the recommendation, physician contact, and peer-reviewed literature used in making the recommendation

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How we serve you with Physician ReviewHow we serve you with Physician Review

  • The Physician Review process begins when the treatment and/or services for a given injury do not meet established treatment guidelines. The reviewing nurse forwards the request to Concentra's Physician Review department, which assigns it to a physician for review of the treatment in question.
  • The physician reviews the case and makes a recommendation based on medical necessity.
  • If there is a question regarding medical necessity, the reviewing physician attempts to contact the requester to discuss the case before issuing a non-certification recommendation.
  • Appealed reviews are sent to a different physician than the initial reviewer. This appeal physician reviews the clinical data and, if there is a question of medical necessity, again attempts to contact the requester. If no contact is made, the physician makes a recommendation based on the medical information provided.

How you benefit from Physician ReviewHow you benefit from Physician Review

  • Quality Assurance – Our program provides accurate assessment and consultation to all parties involved on a timely basis.
  • Thorough Documentation – Physicians document their assessments according to industry standards.
  • Expertise, Depth – Concentra offers over 100 physicians who represent at least 20 medical specialties.

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Learn more at the Concentra Physician Review Web site.

 
 

Concentra is an equal opportunity employer.