People Process Technology


Prizm has assembled a network of dedicated IT, claims and healthcare professionals for medical management. By proactively utilizing medical professionals for Physicians Advisor Reviews (PAR) and IME's, the most appropriate recommendations are made for treatment and diagnostic testing of MVA related injuries. AICRA (Automobile Cost Reduction Act of 1998) allowed New Jersey to implement an administrative process for healthcare claims related to automobile accidents. This process allows carriers to identify certain treatment/tests that may be subjective to overutilization. Aside from the precertification 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.

Key Features of Pre-Certification:

Utilization Review

Prizm Utilization Review Program identifies reasons why a file remains open and determines if further medical management strategies should be utilized.

Utilization Review Report Components include: