Pro-Active 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.