Medlogix’s Utilization Review (UR) services delivers quick turnaround times, comprehensive reporting, and data accuracy via our fully integrated MyMedlogix software.
Medlogix manages the pre-certification process to assess the medical necessity and appropriateness of treatments and care plans for auto insurance and workers' compensation claims. Our case managers and peer review network ensure that services, such as physical therapy, are medically necessary, use appropriate levels of care, and align with clinical protocols and evidence-based guidelines, helping to manage costs and improve outcomes.
"Medlogix is a great partner in building our utilization review program." Carrier client testimonial
What Do Our Utilization Review Services Include?
- Pre-certification: Medlogix manages the entire pre-certification process, reviewing treatment plans to ensure medical necessity and appropriate care duration before services are rendered.
- Case Management: Case managers evaluate treatment plans, check for compliance with clinical protocols, and ensure the appropriate level of care is provided.
- Peer Review Network: We utilize a network of board-certified physicians who specialize in the relevant medical field to conduct retrospective reviews of billed treatments for medical necessity and causal relation.
- Appeals and Dispute Resolution: Medlogix handles the internal appeals process for denied treatments and assists in dispute resolution.
Why Choose Medlogix for UR?
- Experience and Reputation: With a proven track record of providing services for major national carriers, we have earned a reputation for reliability and performance.
- Cost Efficiency: Medlogix offers competitive pricing structures and overall cost savings with transparent billing practices and no hidden fees.
- Customer Service and Support: We pride ourselves on responsiveness to inquiries and issues from insurance carriers and their claimants – a frequent problem with other service providers.
- Compliance and Accreditation: Our services adhere to state and federal regulations, and we are accredited by recognized bodies such as URAC.
- Outcome Management: We focus on improving patient outcomes and reducing unnecessary treatments, coordinating with healthcare providers to ensure appropriate care.
- Quality and Accuracy of Reviews: Our extensive team of medical professionals, including certified physicians and specialists, ensures high accuracy in medical determinations.
Customization and Seamless Integration with Existing Claims Management Systems
- Flexibility and Customization: We meet specific preferences of insurance carriers by adapting to changing market conditions. You can choose just UR, or our full suite of claims management services. It is never an “all or nothing” choice our competitors require.
- Technology and Integration: MyMedlogix UR Manager automates rules for the Bill Review process ensuring precise and efficient outcomes. Unlike other systems, our advanced technology provides seamless integration with existing claims management systems.
- Reporting and Analytics: Our user-friendly reporting system provides insights into utilization trends, procedure trends, highest utilized providers, and expenditures, so billing can be adjudicated based on UR outcomes.
Contact us to learn how our integrated, automated, and highly efficient Utilization Review services can reduce costs, add value to your organization, and improve outcomes.
“Our knowledgeable professionals share a passion for advanced technologies, and a commitment to exceptional client partnerships. We started as a UR company, and we are now a nationally competitive, full-service claims management company utilized by some of the largest insurance carriers in the industry.”
Craig Goldstein, President