Services: Act IV Peer Review

Act IV Peer Review (PRO)

Active Care Auto is a Certified Peer Review Organization (PRO) under Act VI, within the Commonwealth of Pennsylvania. As such, our peer review product meets strict quality and time restriction standards.

An Act IV Peer Review (PRO) conducted by Active Care Auto includes:
 
  • The collection of all appropriate medical documentation for review.
  • A thorough, objective analysis of medical records by a board certified specialist
  • License and specialty to determine the appropriateness of treatment.
  • Determination of medical necessity, goal - oriented treatment, causality issues, and appropriate documentation of patient response to treatment program.
  • Rationale for opinions based on accepted standards of medical practice.
  • A complete report with concise recommendations for denial or future management of treatment.
  • Report reviewed by a Nurse to assure quality and clarity.
  • Time frame: Maximum 90 days; Average 45 days.



 


Request ACT IV Peer Review


Medical Record / Peer Review

Often questions are raised regarding the delivery, appropriateness or necessity of medical treatment/services. When a face-to-face clinical evaluation is not required or possible, Active Care Auto will compile a complete medical history, obtain pertain medical records and have a qualified board certified physician, of like license and specialty, review all medical documentation to provide a comprehensive report with concise recommendations for denial or future management of treatment.

The Medical Record / Peer Review may determine that an individual is receiving treatments which are unrelated to his or her diagnosis, or that charges are being inappropriately billed by a provider.

Distinct benefits that may be derived from a thorough and comprehensive medical review include but are not limited to:
 
  • The determination that no causal relationship existed between the injury/illness alleged and the treatment rendered.
  • The individual may achieve a shorter recovery period if a more focused approach to his or her treatment can be implemented.
  • Substantial savings for the payer may be realized from a more focused treatment regimen, from the shorter recovery period that usually ensues, and from the identification and correction of any inappropriately billed charges.
  • Or as an alternative or prelude to an Independent Medical Examination.


 

 

 

 

 

 

Request a PA Medical Review / Peer Review

 
 
  Active Care Auto corporate office: 2740 Route 10, Suite 304, Morris Plains, NJ 07950 phone: (800)752-5158 fax: (973)257-2287