Medical Utilization Review Services

We assist HMOs, TPAs, hospitals, medical insurance carriers and state health agencies in resolving coverage disputes and evaluate quality of care by providing quality reviews in the following areas:

Medical Chart Review
Medical Imaging Review
Billing and Coding
Plan Interpretation
Utilization Review
Length of Stay
Injury/Illness Assessment
Standard of Care
Pharmaceutical Review
Coverage Issues Review
Usual and Customary
Quality of Care
Medical Necessity Review

Cost-Containment Opportunities often found in MedCase’s review process are:

  • Fraud & Abuse
  • Analysis Solutions
  • Utilization Review
  • Out-of-Network Claims
  • Negotiations
  • Subrogation Recovery Solutions
  • Data Mining & Reports
  • Disease Management
  • PPO Networks