Medical treatment, testing, and products are evaluated to determine reasonableness and medical necessity of care, and the professional standards of performance including the appropriateness of the setting where care is rendered.

Services:

• File review to determine documentation necessary to review provider
• Medical records acquisition
• Medical brief by like specialty provider, compiling a treatment history and addressing issues of dispute
• Telephone discussion with provider, when requested

Benefits:

• Detailed written analysis by practitioner of the like specialty, with evaluation of issues and reasons for decision rendered, as well as the denotation of services that are or are not reasonable and necessary
• Review of peer review report by a registered nurse for consistency and confirmation that all issues were addressed by the peer reviewer
• Prompt delivery of the peer review report to the referral source
• Strict adherence to any state laws that govern the retrospective review process
• In-depth statistical data to provide unprecedented management information for the referral source

Service Request Form

Pennsylvania Service Request Form