Physician Review
What 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 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 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.
