Injury Management - IMO, Utilization Review, Medical Bill Review, Preferred Provider Networks, Customized Hospital Provider Audits, Peer Review

Utilization Review / Pre-Authorization | Medical Bill Review (IMOmbr product) | Peer Review / RME

IMO is certified in several states to provide Utilization Reviews services. IMO's Utilization Review Team encompasses skilled nurses and a selective specialty physician panel to review the cases. It is IMO's mission to ensure quality care that is reasonable and necessary and to reduce the exposure for unnecessary care. Our level of expertise and use of National and State Clinical Pathway Standards extends to the critical knowledge for assessing what is reasonable and necessary when a provider request for a service. In addition, our Utilization Review Software allows for detail reporting and recording of clinical patterns and trends that enhance a quality control mechanism. IMO's Occupational Case Management interfaces with the Utilization Review and encourages a micro-management aim for positive outcomes.

For more information on IMO's utilization review services, please call us at 877.742.4477.

Click here for a printable PDF of Utilization Review / Pre-Authorization.

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IMO has been in business for more than 13 years, and our experience with medical utilization review is interfaced with the medical bill review process. As a result, our combined bill review, medical experience and customer services set us apart in the industry. Our highly automated system combined with an experienced medical bill review team translates into maximum cost savings. Our medical bill review team consists of review analysts, quality assurance specialists, jurisdictional experts and licensed nurses. Through a customized program, IMO bill review process captures savings through:

Application of state fee schedules and mandated ground rules
Usual and customary review
Identification of improper billing practices as in up coding and unbundling
Integration of all utilization review decisions to made appropriate bill review recommendations
Detection of duplicate provider billing
Capability to manage multiple PPO networks
Pharmacy bill review and management
Hospital and ancillary service review

Additional Services Offered:

Automated rules engine
Enhanced EDI interfaces with all appropriate parties
Scanning work flows to incorporate bill images, medical reports and EOBs
Numerous quality assurance measures and controls
Online access to bill review information
Automated provider payment file
Clean and concise reporting (hard copy and/or electronic format)
Compliance with state EDI reporting, EOB approval process and ADL for TWCC

For more information on how IMO’s medical bill review services can help you, call 877.742.4477.

Click here for a printable PDF of Medical Bill Review.

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As cases become more complex and increasingly expensive, it can become necessary to bring in a third, impartial party to assist in the decision-making process. At IMO, we implement peer reviews to make sure that injured patients are treated with the best medical care, in the best long-term interest of the patient's full recovery and return to activity. We believe that the best medical care represents the best value.

IMO will conduct the detail coordination that is needed for a "designated doctor" (DD). This would include the coordination involved with appropriate record collection, DWC forms and process and the DD medical summary that should be available prior to the designated doctor appointment. In addition, IMO has various doctors of expertise within select specialties for "required medical examinations: (RME). We will expedite the process as required by DWC all the way to receiving a valuable RME report to utilize as a tool in order to measure claims and medical status and enhance medical and return-to-work plans.

Click here for a printable PDF of Peer Review/RME

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