Comprehensive, Convenient, Objective
When a face-to-face evaluation isn’t possible
A Peer Review (sometimes called a Chart or File Review) is completed when a face-to-face medical evaluation is not possible or required and questions are raised regarding an injury, diagnosis, level of impairment, or appropriateness of medical treatment.
As a URAC-accredited Independent Review Organization, MCN completes evidence-based medical peer reviews for a wide array of clients in the healthcare and insurance markets. Each specialty-matched peer review delivers a comprehensive, evidence-based report that addresses case-specific questions. Members of our nationwide peer review panel are available to work with all insurance and market types, delivering expert and supported opinions for each case or client-specific needs, evaluating:
- Causality
- Return-to-work concerns
- Restrictions and limitations
- Standard of care
- Diagnosis
- Level of impairment
Additionally, Utilization Reviews comprise a subset of Medical Peer Reviews and answer questions related to the following:
- Appropriateness of treatment
- Medical necessity
- Whether a treatment is considered experimental in nature
Peer Reviews and Utilization Reviews are requested by and are completed for all insurance types MCN serves: Disability, Workers’ Compensation, Auto/PIP/Liability, and Health Insurance Plans. Utilization Reviews can be completed as pre-certifications (before treatment is provided), concurrent (while treatment is being provided), and retrospectively to a course of treatment.
Not sure if a claim should be accepted because there’s some question over how an injury occurred, the relatedness, or the mechanism of the injury? Order an Early Assessment (Mini) Review to learn more.
Additional review types include:
- Family Medical Leave Act (FMLA) Reviews
- Peer-to-Peer Conversations
- Peer Panel Review
- When medical evaluations call for review by more than one medical physician/consultant specialty type.
- Pharmacy Reviews
- Radiology Reviews
- Expert Witness Reviews
- State Specific Reviews
- MCN has individual approval in multiple states to complete review types unique to that state, including Act 6 Peer Reviews in Pennsylvania, and Decision Point Reviews in New Jersey.
State laws and client needs are constantly in flux. With a staff Regulatory Compliance and Business Analyst, we are nimble and responsive to changes in the law and modifies related workflows to always maintain compliance. We are also able to customize reviews to meet your criteria — just ask!
