Team up your claims department with Excel to meet the scope of practice and standards for Utilization Review as defined within CA Labor Code Section 4610.

Click here for the: Online Utilization Referral Form

Download the Utilization Review Form In Adobe Acrobat PDF Format

Excel’s Reviewers, Medical Director and Specialty Physician Reviewers (Acupuncturist, Anesthesiologist, Cardiologist, Chiropractor, Dentist, Otolaryngologist, General Practice, General Surgeon, Internist, Neurologist, Neurosurgeon, Occupational Medicine, Ophthalmologist, Orthopedic Surgeon , Osteopath, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgeon, Podiatrist, Psychiatrist , Psychologist, Pulmonary Medicine, Thoracic Surgeon ) are the backbone of this service. Excel will provide a comprehensive, quality driven utilization management tool to your claims organization. Our network of Physician Reviewers comes from a URAC Independent Review Organization.

Early intervention is highly recommended to allow comprehensive management of the claim from the outset. Once a claim is identified for review Excel will begin the review process by applying the appropriate evidenced based (ACOEM, Milliman, etc.) guidelines.

Following application of the guidelines and completion of the necessary decision making methodology the reviewer will communicate with the claims examiner. Our recommendation will be to either, authorize the medical treatment, request further clarification and supporting documentation from the treating physician, attempt to redirect the treatment plan or direct the issue to a Physician Reviewer. All this will be completed within the required timeframes with necessary EOR’s (Explanation Of Review) to the providers.

All review information will be communicated to those responsible for bill review and payment. This will ensure no payments are made for unauthorized medical services. Excel will even negotiate rates for services not covered by fee schedule and also channel services to PPO’s for better cost management.

Utilization Management should focus not only on the type and duration of medical care, which creates extended disability durations, but also the ability of the injured worker to Return to Work. Claims costs are greatly inflated by unnecessary lost time and Excel will address this within our Utilization Management program.

Options Include

In conjunction with either telephonic or field case management you will have a powerful tool to manage claims.

• Telephonic Case Management with Utilization Review services.
• Onsite Nurse Reviewer(s) located in your claims office.

Call us at: (888) 464-0044 for more information.