 | Appeal Review |
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| NMR’s subsidiary, Insurance Appeals, Ltd., uses a separate panel of specialty-matched physicians to review Appeals. Fairness and consistency are assured because these physicians’ are trained and certified in the same Evidence-Based Medicine principles as all of NMR’s physicians. |
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| Comprehensive Peer Assessment (CPA) |
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| Evidence-based assessment by a Board Certified Specialist, who will perform a thorough evaluation of the claimant's information. The Specialist will determine if there is adequate information in the medical records to accept or reject the opinion of the treating physician who has endorsed disability. If there is insufficient information, the Specialist will perform a teleconference and indicate to the treating physician any additional testing, specialty consultations, FCE, etc., which are needed to support work loss. An IME or specialty consultation, in the claimant's geographic area, will be incorporated as part of the CPA process. Medical literature references will support the Specialist's assessment of functionality. |
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| Education and Certification |
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| HealthScope is an educational video/E-Mail format training program for claims personnel, nurses, physicians and legal staff. This Evidence based Medicine Approach will enhance fairness and consistency of the claims process. |
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| FMLA Review |
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| The appropriate board certified medical specialist will contact the treating physician to obtain additional information on the claimants FMLA claim. After the teleconference with the treating physician, NMR’s specialist will complete a report containing the information gathered from the teleconference. |
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| Functional Capacity Evaluation (FCE) |
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| Testing of an individual's functional ability using national standardized protocols. |
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| Independent Medical Examination (IME) |
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| Evidence-based assessment by a Board Certified Specialist, who has performed an examination in the individual's geographic area. Evidence-based principles will be utilized to assess validity of diagnosis, severity of diagnosis, physical impairments, restrictions and limitations, and retained functional abilities. |
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| Lack of Information Review (LOI) |
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| When no clinical documentation has been submitted on the claimant an LOI review is completed. The medical specialist will complete a report documenting that no information has been submitted and to proceed further with the claim the appropriate information must be received to be reviewed. |
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| Legal Medical Reviews |
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| Helps avoid litigation through its fair and consistent methods. NMR will participate in preparing the defense to litigation by providing records, testimony and explanations of the Evidence-Based Medicine processes that assure fairness and consistency. |
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| Medical Necessity Review |
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| Medical review by board certified medical specialists who will evaluate the care of the insured to determine the medical necessity, and/or investigational/experimental care. Medical literature will be referenced to support the validity and severity of diagnosis, medical necessity of care and/or need for work loss. |
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| Neuropsychological Testing |
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| Testing will be performed by a board-certified neuropsychologist to determine an individual’s psychological status and cognitive abilities. |
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| Peer File Review (PFR) - Disability |
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| Evidence-based medical review by board certified medical specialists who thoroughly reviews and assesses the medical documentation provided. Evidence-based factors will be utilized to support factors such as validity of diagnosis, severity of diagnosis, physical impairments, functionality, restrictions and limitations, and other requested issues. |
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| Peer File Review (PFR) - Workers Compensation |
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| Evidence-based medical review by a board certified medical specialist who thoroughly reviews and assesses the medical documentation provided. National guidelines will be utilized to assess injury, causation, medical treatment and medical necessity. |
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| Utilization Review |
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| NMR is a licensed utilization review company. Physician Centered Medical Evaluations are used to determine medical necessity and appropriateness of care. |
