faq-general

The client sends us a request for services, along with the medical records for the case under review. We record the data and review the referral. If we need clarification of the issues, we will ask.

We determine the specialty based the issues mentioned by the client, then we select the consultant. In special cases, we consult with the Medical Director before making this important selection. Once the reviewer is assigned, we send them all the necessary and relevant information they need to conduct their thorough, anonymous review and notify them of the due date of their report.

Once the reviewer returns their review, we screen it for quality, consistency, and compliance with our standards. If necessary, the report will be revised. When any necessary revisions are completed, we supply copies to the client, return or destroy medical records we received from the client, file our reports, and proceed with billing.

Clients may use our generic form, their own, or write a letter with the required information: name of organization, contact person, address for results, and the specific question to be answered by the review. (i.e., Was this procedure medically necessary? Is this procedure considered experimental? Was this this a preexisting condition? etc.)

A standard or extended case review is returned to the client within twenty business days from the time it is received. An expedited case review is generally returned within 72 hours, unless a different time frame is stipulated in the contract.

Not usually. If you would like to do this, you must notify us at the time of the referral. The identities of our reviewers are kept confidential. We identify them to you by number only. We believe this contributes to the objectivity of the review.

Yes. All of our reviewers sign a conflict of interest statement and renew it regularly. When we select a reviewer for an evaluation, we use a reviewer from different geographical location than the location where the service was provided. Also, all reviewers are reminded, with each review, to return any charts in which a personal or business conflict may occur. In addition, we have a process to track our review results and monitor our reviewers, assessing their quality of and looking for trends that might indicate bias.

We will send your organization a monthly statement for all services completed.