Physician-led peer review is a valuable and scalable method for answering complex medical questions associated with the care of an injured worker. The insight gained from the physician review can better inform future decision making for a claims adjuster, nurse case manager, and defense counsel. Additionally, peer reviews don’t contain the inherent friction created by an in-person Independent Medical Examination (IME) - a process where the injured worker is required to attend an exam and have his/her level of impairment and level of care directly questioned.
Simply stated, the peer review is a less costly and much quicker option for obtaining the opinion of a medical doctor that will more accurately guide the payer organization on next steps related to the care of the injured employee.
At Arbicare, we recognize that not all injuries and claims are equal. The scope and price of our peer review services can change based upon your specific needs and the complexity of the claim. No matter your concern, we have a peer review service to assist.
Scope: UR-like, physician review
Result: Quick turnaround time, minimal financial investment
Scope: In-depth physician review
Result: IME-like review without the in-person exam. Pose an open ended number of questions to receive high-quality and evidence based clinical recommendations.
Scope: In-depth physician review + discussion
Result: IME-like review without the in-person exam and includes attempts at telephonic, peer to peer discussion. Pose questions to be answered and recommend a revised, evidence based treatment plan.
Scope: In-depth physician or pharmacist review + discussion
Result: Review of current medication regimen including a revised and recommended evidence-based treatment plan when medication costs are preventing the claim from settlement. Agreements are captured in writing so the MSA allocation can be revised and settlement can ensue.