Medical Records Review is defined as a review of the medical record.  The reviewer will address the causal relationship, reasonableness and necessity of all treatments and services in the medical record.

Service Request Form

 

Medical Records Review is a retrospective review.  The role of the Medical Records Review is to establish what care is medically reasonable and necessary, based on national norms and to establish causality.  The mechanism of work would be the acquisition of medical records by CSG’s Utilization Review staff.  The medical records are forwarded via US Postal System to the reviewer with an attached cover letter and specific file instructions and questions to be addressed.  Once received, the Reviewer would examine the medical record and make a determination based on the questions and then submit a report following the format provided.