Utilization Review

AmeriSys is a URAC accredited organization holding a certification in Core Standards and Workers' Comp Utilization Management. The AmeriSys Utilization Review department offers all 3 levels of Utilization Review; Prospective, Concurrent and Retrospective. The AmeriSys Medical Director and the physician advisors are readily available to opine on the different issues presented on all three levels.

In providing Utilization Review for surgeries and invasive procedures, we have found 28% of the requested procedures do not meet criteria for certification by third party standards (InterQual). Resultantly in 2011 we saved over $8,067,816 in procedure costs on behalf of our customer partners, and the pain, discomfort and future impairment associated with unnecessary surgical procedures on behalf of the injured employees.

AmeriSys has established and it is our intent to follow appropriate written policies when (i) the injured employee requests a second opinion, (ii) medical evaluation is questioned, or (iii) grievance report is filed.

In regards to Second Opinion, an employee may request a second opinion but it is no longer required by the Florida Statute to provide one, as is reflected in the AmeriSys policy and procedure.

When the medical evaluation and need for treatment is being questioned, the Utilization Management process is initiated. It is our intent to coordinate our efforts to work with the treating physician to provide the highest quality of care to the employee in the most cost effective manner.
It is our goal to promptly and appropriately address and/or resolve concerns and complaints expressed by the injured workers and/or the treating physician.
Customers are encouraged to communicate concerns or issues related to services provided by AmeriSys. We believe this will allow us to improve our services as well as improve communications with our customers.

This communication can be:
  ê Written (email, memo or on the Customer Concern Form)
  ê Verbal (personal meeting or telephone)

Internal procedures dicate immediate implementation of the Customer Concern process to assure full, proper & timely resolution.

 

Additional Services include: 

 ê   Telephonic Case Management
ê   Field Case Management
ê   Utilization Management Team Work             
ê   Medical Bill Review    
 ê   Return-to-Work and Vocational Services       
ê   Corrus

AmeriSys all rights rved
aaaaaaaaaaaaiii