Proactive Utilization Review

Proactive Utilization Review

Utilization Review
- Verification of eligibility, network participation, benefit coverage and medical necessity.
- Detect and notify of duplication and or unnecessary testing or treatment in compliance with CMS/ACC guidelines
Claim Review
- Verify Authorization
- Coverage of the level of visit and CPT code against the medical records.
- Verify and review ICD-9
Patient Tracking
- Real Time monitoring of care.
- PCP will have online access to the Medical Records of their patient files.