Utilization Review

PDI’s Utilization Review philosophy is focused on treating a medical disability or work injury utilizing evidenced based treatment protocols which provide functional restoration and shorten the length of recovery.

The management of medical treatment proactively and collaboratively with the medical provider results in arranging the right service- at the right time- in the right setting, producing more cost-effective outcomes.

We provide full utilization review services conducted by appropriately licensed medical professionals, utilizing our proprietary software system QCare. These services include:

  • Prospective Review
  • Concurrent Review
  • Retrospective Review
  • Reconsiderations
  • Appeals Process
  • Chart/File Review
  • Physician Peer Review

The PDI Advantage

  • Our nurse professionals work with the requesting to provider to negotiate medical treatment in accordance with evidenced based treatment protocols. This negotiation reduces the client expense of physician review fees and expedites medical treatment.
  • We assist our clients, during program implementation, to develop utilization review referral criteria to ensure only the treatment requests requiring utilization review are referred to PDI.
  • Our UR services provide high client satisfaction with an average of 6:1 cost savings and prompt processing of requests decreasing days away from work.
  • Medical provider satisfaction is demonstrated through our low appeal rate of .69%. Less than 1% of our physician review decisions are appealed.
  • Proven success in California Utilization Review – Client audit scores of 94 to 100% with no penalties assessed.

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