Assistance is frequently needed to provide additional medical oversight during the claims process but, all too often, adjusters do not have a “go-to” resource for quick, medical questions. That’s what we provide.
Rising allows adjusters to pick-up the phone or drop us an email to “Ask-A-Nurse” for medical guidance on any of their cases. From answering questions about experimental treatment to reviewing a case which may benefit from pre-negotiation of surgery charges to advising if a Physician File Review is a good idea; our nurses help adjusters with uncertainties regarding the medical components of a claim.
In some instances, Rising nurses even arrange for clients to tap into our Medical Director’s expertise through question-and-answer sessions on various topics. Whatever we can do to ensure medical clarity and appropriate care, Rising will provide for clients.
Here’s what our nurses can do for you after review of the file:
• Field any medical questions during the claims handling process
• Apply evidence-based guidelines when supplying answers
• Identify red flags in a claim that could unnecessarily increase medical costs
• Provide access to our Medical Director for additional expertise
• Recommend other Care Management or Utilization Management services when appropriate