Services
Payor Review Services
and Products
- Pre-Certification/Pre-Authorization (Level Two and Level Three Reviews)
- Concurrent Review
- Retrospective Review
- Chart Audit/Coding Review for appropriateness and accuracy
- Appeals/Second Opinion Review/third party arbitration
- Expert Testimony/Consulting
- Analysis of physical medicine and rehabilitation treatment patterns to develop algorithms for appropriate utilization criteria in automated claims processing systems
AUG - Payor Review Goals
- Eliminate abusive and unnecessary physical medicine and rehabilitation care, minimize the chance of patient dependency on the provider, control the costs of the claim, reduce the adjuster/case manager workload, minimize the potential for litigation, and ensure patient progress.
- Facilitate fair claims by controlling the benefit dollar to match the clinical need of the patient. Supplying our customers with impartial peer reviews will also help to identify cost savings.
- Facilitate communication between payers and providers by having reviews performed by professionals with an appropriate body of knowledge. These knowledge-based practice parameters will help prevent clinicians from embellishing for unreasonable services, assure efficacy of treatment, increase the probability of a positive clinical outcome, and limit potential litigation issues.
- Flexibly design quality products and services in the utilization management industry that exceed customer expectations. We will deliver these services maintaining the highest standards in customer service, staff credentialing, and timeliness at a competitive cost.
- Educate our customers about effective rehabilitation services to facilitate win-win-win situations between payers, providers, and patients.
Download the AUG Referral Form
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