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 Utilization Review 

 

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

 

 

 
Utilization-Review-Services_Workers-Compensation
 


QUALITY NATIONWIDE:
96-99% Provider Acceptance Rate of Rising's UR Decisions


depending on the state
 

Inquires

 Email:

info@risingms.com 

 Call:

877.747.4644

Customer Service

 Call:

877.678.4404 (for Texas)

888.678.4489 (for all other states)

 Write:
 

325 N LaSalle St, Ste 600
Chicago, Illinois 60654
 

Utilization Review: A Dependable Cost Cutting Tool
Hear from us on this topic in a "Self Funding Magazine" Feature
 



 
 
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