Who We Are
About our advisory panel
Concentra, through its affiliated providers, provides a full range of services to serve the workers' compensation and occupational health industry.
What is physician review?
We are: A business unit of Concentra, a leading provider of medical services for the occupational health industry.
We offer: Hundreds of advisors.
Our clients are: Utilization review companies, insurance carriers, third-party administrators, large self-insured employers, and others
We provide:
- Expert evaluation of the medical necessity of a requested treatment;
- physician-to-physician contact if denial determination is expected; and
- a complete written report detailing the recommendation, physician contact, and peer-reviewed literature used in making the recommendation.
Clients call on us: When a utilization review has determined that the treatment and/or services for a given injury do not meet established treatment guidelines.
Our affilated physicians: Located throughout the country, our physicians review cases originating in virtually every state in the nation.
Concentra Physician Review: Our headquarters are in Addison, Texas, north of Dallas (Contact us at (800) 563-1705).
Clients call on us: They have the assurance that comes with a network of hundreds of affiliated physicians specializing in over 30 practice areas and our affiliation with Concentra.
URAC Accreditation
The Concentra Physician Review program is accredited by the Utilization Review Accreditation Commission (URAC) in the following area:
- Workers' Compensation Utilization Management Accreditation Program
(Links to summary descriptions of these programs on URAC's website are provided in the right hand column.)
In addition to URAC standards, the Concentra Physician Review program complies with all state guidelines.
URAC is a leader in the accreditation of health and managed care organizations. Founded in 1990, URAC currently offers over 20 accreditation programs that span a broad spectrum of health care services.
The URAC accreditation process demonstrates a commitment to quality services and serves as a framework to improve business practices through benchmarking organizations against nationally recognized standards. Appropriate reviewer credentials, quality assurance measures, turnaround time compliance, and a high-quality medical directorship role are part of, but not all, the criteria for accreditation.
Timeliness
Concentra's affiliated physician reviewers consistently complete reviews on time.
Reviewer responsibilities
Outsourcing your Physician Review service to Concentra's Physician Review program could help you realize savings in time and claim costs.
Physician Reviewers are responsible for:
- Accessing the web site where they receive requests
- Providing reference to the appropriate medical guidelines used in arriving at their recommendation / determination
- Posting determinations in a timely fashion to support Concentra's turn-around-time performance goals
- Making an effort to reach treating physicians in the event additional information is necessary and/or if a recommendation for denial is anticipated
- Following all HIPAA and privacy regulations, policies, and procedures
I encourage you to explore the opportunity to affiliate with Concentra. If you have questions that you would like to address to a physician, please contact us at (800) 563-1705. We welcome the opportunity to speak with you.
Barry Korn, M.D.
National Medical Director, Concentra Physician Review/Utilization Review
