Personal Injury Protection (PIP)  ~  Bodily Injury (BI)  ~  Retrospective Utilization Review (RUR)  ~  Prescription Fraud   

  • Review, streamline, and summarize complex medical data.
  • Prepare chronologies of medical events. 
  • Assess alleged injuries and identify factors that caused or contributed to the damages and/or injuries. 
  • Provide Peer-to-Peer Medical Record Reviews in order to determine causal relationship, medical necessity of treatment, and for the relatedness of treatment and diagnostic testing to a claimed injury.  
  • Bill Reviews.  Billing codes are compared to the documentation within the medical record in order to ensure proper code usage as well as identifying evidence of up-coding, unbundling, and other forms of fraudulent billing.
  • Usual & Customary Rates (UCR) Reviews.  Charges are compared to a nationally recognized database for reasonable and customary rates for a specific geographic area.  
  • Opioid Fraud Investigation.  Medical records are reviewed for proper prescribing and management of patients on opioid medications.  Pattern analysis are performed in order to identify trends with regard to the prescribing and monitoring of patients.