Medical Review Stream Doctor Lab Coat

Peer Review Referals

EVIDENCE-BASED, CLINICAL REVIEWS

Concentra’s Medical ReviewStream™ (MRS) provides peer review services to complement Utilization Review (UR) operations and claims handling/adjusting services where excessive or inappropriate treatment and services may be prescribed. Our licensed peer reviewers can provide the following types of medical opinions:

  • Utilization Review: The provision of medical necessity opinions on the back end of UR for initial physician/peer reviews and reconsiderations/appeals
  • Claims Adjudication Services: The provision of medical opinion services that supports the claims process, including:
    • Medical necessity opinions outside of the UR process
    • Causality
    • Relativeness
    • Drug/Pharmaceutical 

    DISCLAIMERS & TERMS

    • Medical ReviewStream by Concentra will provide medical option services per current URAC standards with respect to Utilization Review medical necessity requests.
    • Medical ReviewStream by Concentra determination reports are sent to the submitter of this referral form.  MRS does not prepare or send mandated letters or notifications to requesting providers, patients, or their representatives.
    • Concentra will invoice you no more frequently than monthly, and you shall remit payment to Concentra within thirty (30) days of receipt of invoice. Any payment that is not made by you within thirty (30) days of receipt of Concentra’s invoice shall bear interest at the rate of one and one-half percent (1.5%) per month, or, if lesser, the maximum rate permitted by applicable law.
    • Each party will comply with all applicable federal, state and local laws, including, but not limited to, the Health Insurance Portability and Accountability Act of 1996, as amended, and all regulations promulgated thereunder.
    • Each party hereby agrees to fully, completely, and unconditionally indemnify, defend, and hold the other party and such other party’s directors, officers, employees, agents, and affiliates harmless from and against any and all claims, actions, liability, loss, cost, and expenses (including, without limitation, costs of judgments, settlements, court costs, and reasonable attorneys' fees) arising out of or relating to, or alleged to arise out of or relate to, negligent or intentional acts or omissions of the indemnifying party (and/or its directors, officers, employees, agents, or affiliates) or any failure by the indemnifying party (and/or its directors, officers, employees, agents, or affiliates) to perform any obligation or covenant of the indemnifying party