Utilization Review/Precertification
WellComp™ implements utilization review to ensure clients never pay more than necessary to return employees to work.
Our experienced examiners use nationally recognized medical care guidelines to assure only appropriate medical care is provided.
Our utilization review is performed completely in-house, which makes daily coordination with claims adjusters easy, ensures greater oversight of the claims process,
results in fewer margins for error and increases communication – all of which produce measurable savings.
Our utilization review and precertification features include:
- Documented reduction in medical bill volume
- A multi-tier chart of medical services, able to be filtered by requests for authorization
- Teams consisting of medical directors, nurse case managers, utilization review coordinators and assistants
- All employees versed in usual and customary medical procedures
- Elimination of treating physician presumption of correctness – referral process is instead centered on evidence-based medical protocols
- Seamless hand-offs to other managed care services, including bill review and return-to-work specialists
- Access to a medical provider network in California