The field of healthcare is actively and rapidly evolving, resulting in the constant development of new technologies and techniques involving medical treatment. With all these new developments, Pacific Medical Review and Consultation can assist in the complicated process of ensuring that the appropriate utilization of medical care is fulfilled.
The qualified professionals involved in Pacific Medical Review and Consultation represent a panel of experienced practicing physicians, psychologists, and physical therapists who assist in evidence-based utilization support.
Workers' Compensation: Workers’ compensation covers the cost of medical and rehabilitation treatments for employees who have sustained an industrial injury, resulting in the loss of wages. Workers’ compensation is required by all 50 states, and the peer-reviewed evidence utilized to determine the appropriateness of medical treatment depends on the regulations dictated by each state. PMRC specializes in the application of standard state or industry guidelines to an array of clinical scenarios in order to provide consistent, evidence-based utilization support. Our network of skilled providers can provide comprehensive assessments from a variety of specialties with a guaranteed rapid turn-around.
New Developments: As providers adapt to the development of new technologies and techniques within the medical field, our team can assist in deciphering the evidence to appropriately determine what works and what does not.
Private Insurance: PMRC can also apply our knowledge and techniques utilized during the process of reviewing cases involving Workers’ Compensation to the reviewing of the utilization of medical treatment for private insurance companies. We can review clinical scenarios in congruence with the current insurance policy to determine the medical necessity of the proposed treatment alongside the coverage specified within the insured’s policy.
Auto Insurance: Similar to the application of the utilization review process for private insurance companies, we can also apply this process to determine the medical necessity of treatments resulting from a motor vehicle accident. This process would involve thoroughly researching the claimant’s auto insurance policy and comparing this policy with the proposed medical treatment.