Medical Review Services
Physicians and Specialties
Medical ReviewStream™ provides a unique peer review offering for chart and causality reviews, as well as other physician advisory services that fall outside of utilization review. Our traditional scope of services includes:
Peer review as a part of the overall Utilization Reviews Process addressing the medical necessity of treatment that is prospective (not yet initiated), concurrent (ongoing), and retrospective (provided, but UR should have been requested).
Claims Adjudication Services
Medical ReviewStream™ provides medical review services to complement claims handling and claims adjusting for specific cases where there may be excessive or inappropriate treatment and services being prescribed.
- Complex Chart Reviews — When a patient’s treatment or medical services need evaluation, our fully credentialed medical review team can provide a sound medical opinion on any and all medically related questions you may have about the case.
- Pharmacy Reviews — Medical review services to complement claims handling and claims adjusting for specific cases where there may be excessive or inappropriate drug therapy being prescribed.
- Short- and Long-term Disability Reviews — Our affiliated physicians perform medical review of the appropriate duration of care, medical necessity of continued time off work, and work restrictions for the short- or long-term disability claim.
- Family Medical Leave Act (FMLA) Reviews — We provide a medical review service for cases where there may be a question regarding the provider’s recommendation for the duration of time off work under FMLA.
Service Delivery Options
- One-Stop Shop — Medical ReviewStream™ provides 100% coverage for all of a client's physician review needs
- Appeals and Overflow — Medical ReviewStream™ provides overflow and specialty match coverage
- Dedicated Physician(s) — Medical ReviewStream™ provides dedicated Medical Advisors and/or Medical Directors who are recruited, hired, trained, and screened for quality assurance by Medical ReviewStream™
Our Medical Advisors
The Medical ReviewStream™ program includes hundreds of affiliated physicians, many of which are primary care physicians in Concentra's national network of medical centers. The doctors on our medical review team are Board-certified, licensed, and have special certificates required by the state in which they practice.
Concentra performs additional credentialing by carefully reviewing our Medical Advisors’ curriculum vitae, checking the National Practitioners Data Bank (NPDB) and Healthcare Integrity and Protection Data Bank (HIPDB) for information on candidates, and having their applications reviewed by our National Medical Director. With Medical ReviewStream™, you can be confident that your cases are quickly and accurately reviewed by the most qualified experts in clear compliance with all state and HIPAA regulations.
- Aerospace Medicine
- Infectious Diseases
- Internal Medicine
- Pain Management
- Emergency Medicine
- Physical Medicine and Rehabilitation
- Family Practice
- Occupational Medicine
- Preventive Medicine
- General Surgery
- Oral / Maxillofacial Surgery
- Orthopedic Surgery
- Massage Therapy
- Physical Therapy
- Chiropractic Care
- Occupational Therapy
- Psychology / Neuropsychology