Utilization Review and Peer Physician Advisor Review Services

Sometimes you can’t be sure the specific medical care recommended or already provided to an injured worker is appropriate and necessary. That’s why Mitchell provides a defensible utilization review program—for those times when you need additional expert decision-making help at your side. Our services help insurers comply with individually mandated state and URAC guidelines, as well as state reporting of utilization review services when required. Mitchell holds a URAC accreditation for Workers’ Compensation Utilization Management.

Utilization Review

Mitchell’s utilization review services include prospective, concurrent and retrospective review to optimize treatment of a patient’s injury at any stage of the claim. Mitchell’s utilization review nurses complete first level reviews of specific treatment requests, utilizing nationally recognized and state-specific guidelines and best practices to determine if treatment is within guidelines. If a treatment request is not within guidelines, a second level peer review by a physician advisor is engaged.

Peer and Physician Advisor Review Services

Mitchell’s specialty matched panel of directly contracted physician advisors deliver evidence-based decisions with effective peer-to-peer conversations for timely reviews and high quality scores. Our wide range of staff and physician advisors review the medical necessity of treatment in compliance with URAC guidelines. Our physician advisor panel offers national coverage, same-state licenses when required or needed and specialty matching using expert criteria.