Verify the need for ambulatory care prior to treatment.
MedReview’s Prior Authorization program is designed to ensure that all tests and procedures are medically necessary and performed at the appropriate level of care. This includes a review of ambulatory procedures, high tech imaging studies (e.g., PET scans, MRI scans, CT scans), outpatient psychiatric treatments, home care services, physical therapy, speech therapy and occupational therapies.
Before outpatient services are scheduled or performed, providers contact MedReview to outline the diagnosis, proposed course of treatment, potential diagnostic procedures involved, anticipated date of treatment and the setting in which the procedures will be done, as well as provide clinical information for review.
This information is evaluated using nationally recognized, value-based criteria, as well as the insurance plan’s benefit allowances. After our clinical team completes a thorough clinical review, a decision is made about whether the procedure, test or therapy is medically justified. In the event of a denial, the requesting provider will be notified of the denial rationale and options for appeal will be provided.