Medical Management for Motor Vehicle Accidents
PRIZM's dedicated network of IT, claims and healthcare professionals for medical management expedite and simplify AICRA observance. Our solution allows carriers to identify certain treatment/tests that may be subject to over utilization. Aside from the pre-certification process, New Jersey also has comprehensive fee schedules for physicians, durable medical equipment, home healthcare, transportation, ambulatory surgical premier centers and dentists, as well as penalties/co-pays if providers don't follow the administrative process.
Beyond the platform, our professionals include physician advisors and examiners who can provide Reviews and IMEs, establishing the most appropriate recommendations for treatment and diagnostic testing of MVA related injuries.
Key Features of Pre-Certification:
- Nurse review of submitted treatment plans in accordance with the Care Paths and approved DPR Plan Pre-certification requirements
- Comprehensive Physician Advisor Review Panel Doctors
- Utilization Review for the life of the file
- Dedicated Case Managers
- Virtual Mail Room
PRIZM's Utilization Review Program identifies reasons why a file remains open and determines if further medical management strategies should be deployed.
Utilization Review Report Components include:
- Review of file for medical management.
- Determine why a file remains open e.g., lapse in treatment.
- Determine if further medical management strategies should be utilized.