Utilization Review and Peer Review Solutions
Accelerate recovery through prompt, reasonable and necessary care
Experience tailored workflows that empower clients and improve patient outcomes in a complex medical landscape.
Simplify the Medical Decision-Making Process
Genex’s Utilization Review Services help accelerate and improve decision-making and delivery of appropriate care for individuals. With results exceeding URAC and/or state requirements, our expedited decisions and treatment scheduling saves administrative time and burden, while ensuring the injured/ill individual gets the care they need as quickly as possible. This easy-to-use process has minimal information requirements for the decision. Services include:
- Prospective review
- Concurrent review
- Retrospective review
- Or peer review as a stand-alone service
Tailored Workflows and Service Delivery Models
Our flexible service delivery models are unique to each client based upon your priorities and goals. Our proprietary utilization review system and automated technology incorporates evidence-based guidelines and applicable jurisdictional rules and seamlessly integrates with case management, bill review, and pharmacy benefit management giving you greater control over care and medical spend across the continuum of care. Our service delivery models include full-service utilization review and peer review, standalone peer review, or overflow to supplement your internal operations.
Regulatory Compliance Focused
Genex has been accredited by URAC in Workers’ Compensation Utilization Management since 1996 and holds an additional accreditation as an Independent Review Organization (IRO). As a national provider of utilization review services, you can rely on Genex’s jurisdictional, workers’ compensation and auto expertise to meet all regulatory requirements.
Automated, Customizable & Exceptionally Efficient
Our intelligent managed care software Mitchell ReviewStat is designed to streamline the care continuum. Enhance your medical management program with Mitchell ReviewStat. This highly automated workflow solution is built to facilitate and monitor the progress of cases for utilization review, peer review, case management and more. ReviewStat automates decisions and streamlines processes, allowing your clinical team to focus on providing better outcomes. Mitchell ReviewStat provides the following features to help you boost efficiency and improve quality:
Reporting Functionalities
Clearly understand program performance with custom ad hoc export capabilities and quality assurance reporting options to support managers in real-time.
Multi Service System
Utilize our built-in peer review services or integrate your peer review vendor software systems with our platform.
Automation Capabilities
Automate your medical management interactions for utilization review, peer review or case management assignments and tasks to qualified reviewers by leveraging our assignment and workload balancing rules engines.
Efficient and Customizable Technology
Realize greater efficiency and productivity from your medical management team with advanced automation and customized views.
Flexible Workflows
Meet business-specific needs with our automated capabilities and functionality.
Benefits of Using ReviewStat
Our customer-centric software, including our robust rules engine, seeks to deliver quality outcomes for clinical professionals by:
- Enhancing quality and creating more accurate and consistent outcomes.
- Automating decisions, thereby allowing clinical reviewers more time to focus on important tasks.
- Eliminating manual administrative tasks by streamlining multiple processes.
- Accelerating communications between the various stakeholders and medical providers involved in the medical management lifecycle.
- Improving productivity by conveniently integrating with other platforms.
- Reducing medical review costs.
- Tracking work abilities, lost time and auto-assessing Return to Work using benchmarks and automated savings calculations.
- Allowing customers, through robust and configurable modules, to easily auto-generate invoices, progress reports and activity notes.
By leveraging ReviewStat, customers can experience up to a:
- 99.9% uptime each quarter
- 50% efficiency gain
ReviewStat for Michigan Auto Utilization Review Requirements
Mitchell ReviewStat helps carriers perform retrospective utilization reviews in compliance with the Michigan utilization review administrative rules that went into effect on July 2, 2020. Click here to learn more about Mitchell’s auto casualty solution offerings, and fill out the form below for more information about Mitchell’s Michigan utilization review capabilities.
Peer Review
Genex’s industry-leading peer review program provides clinically sound, defensible reviews, targeting unnecessary medical costs and procedures with input from actively practicing physicians. Our national network of credentialled and licensed physicians cover all specialties and meet all jurisdictional requirements. Physicians are available for both initial and appeal-level reviews.
Learn MoreGenex Services Grievance Process
The Genex grievance process addresses all formal complaints regarding non-clinical and non-determination related Genex processes or services. The grievance process does not address the clinical decision focuses on concerns with the process or people involved in developing the determination. Examples of grievances could be complaints that the utilization review decision was not done within time frames established by the Labor Code or that the physician who rendered the determination was not licensed.
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Provide Better Clinical Outcomes
To accelerate the delivery of optimal care and expedite recovery, we offer a FREE consultation with one of our experts. Together, we will begin to build a customized utilization review program to meet your company’s unique needs.
