How We Serve
Physician review services
Our Services
The Concentra Physician Review program provides a unique peer-review offering for chart and causality reviews and other physician advisory services that are outside of Utilization Review. Our traditional scope of services is as follows:
- Utilization Reviews. Peer review as a part of the overall Utilization Reviews Process address the medical necessity of treatment that is prospective (not yet initiated), concurrent (ongoing), and retrospective (provided, but UR should have been requested).
- Physician Advisory Reviews (PARs). PARs assess the medical necessity of past and future treatment, duration of care, return-to-work issues, work restrictions, or anticipated date of maximal medical improvement or permanent and stationary status.
- Family Medical Leave Act (FMLA) Reviews. Our affiliated physicians review cases in conjunction with the patient's provider to obtain clarification and verification of the FMLA form.
- Short- and Long-Term Disability Reviews. Our affiliated physicians perform medical file and physician 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.
Our Process
The Concentra Physician Review program handles all the administrative functions of the physician review component of the overall Utilization Review process as well as for chart reviews including:
- Locate a board-certified, credentialed doctor to perform the review
- Find out if the doctor is available to accept a case
- Forward a request and clinical records
- Follow up with the doctor
- Review the physician's determination for spelling errors and responsiveness to the request
- Reassign any reconsiderations and/or appeals
Quality Assurance
Concentra's Physician Review program monitors quality at many levels:
- The national medical director periodically pulls charts at random and performs a 35-point detailed review to assure that reviewers are documenting contact with providers, determinations are clinically sound, and rationales are complete and evidenced-based with citation of nationally accepted guidelines and/or peer-reviewed literature.
- Charts are also reviewed to assure that files are assigned to the appropriate medical specialty.
- The physician review process is tracked and monitored to ensure that reviews are returned on time. If any issues are noted, the physician reviewers and staff are retrained to assure compliance with the process.
