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.

• 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.

• 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