Rising’s nurses and physicians guide payers and patients through the medical care process. Our workers' compensation Utilization Review (UR) services deliver appropriate, clinically sound treatment recommendations that result in: more rapid recoveries, faster workplace returns and cost effective outcomes.
Here’s a snapshot of Rising’s Utilization Review program:
• URAC Accredited
• Prospective, Concurrent and Retrospective reviews
• Pharmacy / Drug Utilization reviews
• National capabilities with licensures in appropriate jurisdictions
• Evidenced-based national guidelines or state specific guidelines (e.g. ODG for Texas and MTUS for California) are applied to both approvals and modifications / denials
• National panel of credentialed, board-certified physicians
• Peer reviews conducted by physicians of the same specialty
• Single digit appeal rates in every state - significantly lower than industry averages
• UR-Bill Review system integration, with adjuster treatment alerts
In addition to Rising’s stellar program results, you get complete transparency:
• Cost savings reports on denied / modified services – hard savings only
• Compliance metrics by state measuring Utilization Review turn-around time