Utilization Review & Physician Advisor Services
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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.

 

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