Utilization Review

Fundamental Value

Utilization Review is critical part of any medical management program. It helps to prevent inappropriate medical care that often leads to extended claim life and poor outcomes.

Arbicare is URAC accredited and 100% focused on UR inside of workers’ compensation. We are uniquely positioned to listen and implement custom programs to meet your needs.

Arbicare's Comparative Benefits:

We recognize that the unique circumstances for each payer warrant a customized approach for each organization. We approach each implementation as an opportunity to listen and observe, allowing us to implement the solution that works best for you - not what's easiest for us.


The King v. CompPartners case in California was a sigh of relief for most UR companies in workers' compensation. For Arbicare, it was a call to action. Injured workers need proper warning. Providers need education. Payers need to reduce risk related to discontinuation of certain medications. PharmUR considers each party and provides patient specific weaning criteria inside the UR decision – all done within the confines of the regulatory timeframe.

UR Summary

UR determinations are historically not user friendly. They are filled with pages of detail listing extensive regulatory requirements – most of which aren't important to a claims handler and obfuscate interpretation of the outcome. Arbicare's UR Summary is a single page document constructed specifically for the claims handler. It contains exactly the information he/she needs from the UR decision to take the next step in administering the claim. Quite simply, the UR Summary is our way of improving the user experience and better serving the claim administrator.

Compliance/Regulatory Guidance

Each of our clients receives a jurisdictionally-specific implementation based on geographical footprint, existing resources, and the claims management philosophy instilled by your leadership team. Additionally, as new regulations are introduced (e.g. state drug formularies), you will be educated on the ramifications and provided a recommended action plan to becoming compliant with the new rules and maximizing the benefits associated with the changes.

Nationwide Coverage

Any jurisdiction, any speciality, any request - we have you covered.

Modern UR Software

Our UR platform was built in 2021 and done so to allow rapid changes. Requested changes don't need developers and don't need time - they are most often implemented within 48 hours. The software has custom approval lists and evidence-based recommendations. Users may monitor progress through live data dashboards and track outcomes without request.

Workers' Compensation needed upgraded UR technology to fit today's needs.  That solution is here.

Dedicated Client Advocate

Client service is something you should expect from any managed care partner. At Arbicare, each client has direct access to senior leadership along with a highly educated and focused point of contact ready and able to answer your questions and make requested adjustments without delay.

Actionable Data Analytics

Clients have access to live data dashboards through our modern UR platform. Users can customize dashboards to track data that matters.

The data will uncover hidden trends and produce analysis that will help improve your claim outcomes.

Litigation Support

Our goal and entire program vision is to prevent litigation to every extent possible. Where that isn’t possible and additional support from our physician reviewers is necessary, we will coordinate schedules, depositions, and any additional requirements necessary as set forth by our client and defense counsel.

Network Integration

Using Arbicare's proprietary UR platform (ASAP), we will work directly with our client’s network partners to ensure that clinical decisions are reliably informing each component of the managed care process through API.  Our only incentive is to make certain that medically inappropriate care isn’t unintentionally provided, enabled, and paid for.

Program Overview Statistics

Discussion Rate
$3.45 : $1
On Time %
Appeal Rate
Turnaround Time
2 business days

Client Service Statistics

Avg. Confirmation of Referral Timing
2.5 Minutes
Phone call answer percentage
Avg. time to resolve an issue
1.25 Hours
Avg. time to implement custom changes
1 business day

Employees who are valued during difficult times are employees who recover

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