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Decision Point Review Plan

A decision point review evaluates care at specified intervals within a course of treatment. Standard courses of treatment for injuries are reviewed and compared to the NJ Department of Banking and Insurance Standard Care Paths. Active Care's Medical Director Panel will review medical treatment if it falls outside of usual and customary care. Recommendations regarding the Decision are made with 24 hours of the date referral.


Decisions are based on:
State Mandated care paths
Nationally recognized standards of care
Medical and Diagnostic Records
Customary Care
The claimant's individual medical history
Direct contact with the provider to ascertain additional information regarding the physician's treatment plan
Internal Appeals Process - Medical necessity is determined by a physician


119 Littleton Road
Parsippany, NJ 07054
Tel: (973) 257-5200
Fax: (973) 257-5315

 
 
 
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