Medical Review Stream Doctor Lab Coat

Peer Review Referrals

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