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Four Pillars of Best in Class Utilization Review

Technology

From a client access portal to customized outcome reports, PDI's Utilization Review platform provides a state-of-the-art foundation to our UR program.

Submit referrals online or via electric data interchange. Run real-time outcome reports. Track and trend by employer, physician or treatment type. All from your own computer. Or, customize your own outcome report and timeframe and have the reports delivered to your e-mail.

Nurse Review

PDI Nurse Reviewers combine years of experience in the industry with the use of our Utilization Review platform to create seamless processing of a treatment request in the initial stages. 

Nurse reviewers complete first-level reviews to determine if a request is within guidelines. Maintaining an open-line of communication with the provider, the nurse can attempt to negotiate the request with the provider or forward the request on to PDI's internal Physician Review Department.

Physician Review

 

PDI’s philosophy is to provide the injured worker with quality medical treatment that is directed to treating the work related injury, providing functional restoration, shortening the length of recovery, and in accordance with the applicable medical protocols.

 

Utilizing evidence based guidelines our Physician Reviewers not only review for medical necessity but also work to establish a relationship with the treating physician. The result is a combined effort to eliminate unrelated or unproductive treatment and facilitate the right treatment at the right time.

Timeliness  & Accuracy

With a 99.4% rating from the State UR Audit in 2016, our clients can rest assured that PDI's Utilization Review program is adhering to the requirements set forth by the State of California. 

In addition to the required decision notices, our UR determinations can be transmitted in real-time to claims or bill review systems. 

or use our