Utilization Review

Workers' Compensation medical costs continue to escalate, so much so that medical expenses now outweigh indemnity costs. Medical utilization is one of the key factors contributing to these rising medical costs. MediCall's proven Utilization Review program can assist in mitigating rising medical expenditures due to inappropriate procedures or overutilization while ensuring appropriate quality care is delivered promptly. Our utilization review plan is fully compliant with all URAC and jurisdictional standards. MediCall's US-licensed RN staff provides service in all states, while partnering with a nationwide provider of peer review services with board-certified, US-licensed, practicing medical professionals.



Key Features:

  • Prospective review
  • Concurrent review- including in-patient length of stays
  • Retrospective review
  • Appeals
  • Reconsiderations
  • Drug utilization review


MediCall's state-of-the-art technology ensures timely and consistent decisions are delivered with required jurisdictional language in all communications. Our ability ranges from providing a full turnkey solution complete with clinicians and software platform, to having our clinicians working directly within our clients own existing software as a completely transparent extension to their own domestic nurse teams. Our quality assurance program ensures the highest degree of compliance with regulatory processes and consistent sound clinical determinations based on medical necessity.


UR Support

MediCall can also provide utilization review support services performed by our nurses using our customer's software. Utilizing this service enables their UR team to become more efficient and effective by off-loading some of the more administrative tasks in the UR process such as:


  • Request for medical reports
  • Preliminary review and setup of the UR case
  • Documentation of medical findings
  • Preliminary application of guidelines
  • Notification of UR determination

MediCall Utilization Management Consumer Rights and Responsibilities


Consumer Rights

  1. To be treated with dignity and respect.
  2. To receive complete information about the diagnosis, proposed course of treatment or procedure, alternate courses of treatment or non-treatment, the clinical risks involved in each, and prospects for recovery in terms that are understandable to the consumer, in order to give informed consent or to refuse that course of treatment.
  3. To every consideration of privacy and to expect that all communications and records related to his/her care will be treated as confidential.
  4. To be given access to the utilization management department for timely responses to questions and requests made for service.
  5. To be given information on how to file a complaint.
  6. To be informed of MediCall utilization management policies including how to file an appeal when requested.
  7. To be informed of utilization management criteria used to authorize, modify or deny health care services when requested.

Consumer Responsibilities

  1. To be familiar with the benefits and exclusions of the consumer's workers' compensation coverage.
  2. To provide the consumer's health care provider with complete and accurate information regarding past illnesses, hospitalizations, medications, and other matters related to health status.
  3. To treat the utilization management staff with respect and dignity.