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Utilization Review & Physician Advisor Solution

Clinicians review procedures for medical necessity, using evidence-based guidelines to support their decisions

Utilization Review

Coventry’s industry-leading UR program provides clinically sound, defensible reviews, targeting unnecessary medical costs and procedures with input from actively practicing physicians. UR services include prospective, concurrent, and retrospective review of health care services based on medical necessity. Nurses complete first-level reviews and determine if the treatment is within guidelines. If the treatment request falls outside of guidelines, a physician advisor is engaged.

Physician Advisor

Coventry Physician Review services provides a wide range of staff, consulting physicians, and other health care professionals, who review the medical necessity of treatment requests in support of our URAC-accredited and state-certified UR program. Our service complies with all required regulations and review guidelines.

 

Coventry Connect: Informed decisions lead to better outcomes

The more information that claims adjusters have, the better decisions they can make. With Coventry Connect, you can see all activity on a claim and receive customizable alerts. Our secure web and mobile technology supports Bill Review, First Script® Pharmacy Benefit Management, DMEplus®, Case Management, Utilization Review, IME services, and Coventry’s extensive national network of providers and pharmacies.

    

 

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