Utilization Review and Clinical Peer Review

Conduent, a leader in casualty claims management, is URAC accredited for Workers’ Compensation Utilization Management.

With today’s unrelenting focus on improved patient outcomes and cost reduction, having an effective utilization management program is more important than ever. Conduent’s utilization review services and peer review physician resources ensure patients receive safe and timely medical care while assuring the delivery of effective treatment at appropriate cost.

Strataware® Utilization Review

Our utilization review solution for Strataware® medical bill review software and service customers can be integrated with any claims management platform. Strataware Utilization Review is executed on a high-performance rules engine that automates all aspects of UR, from request and intake to clinical reviews, communications, and appeals. You’ll experience a fast-paced, streamlined process that results in higher rates of auto-adjudication and increased approvals or modifications to move claims toward closure.

  • Fast first-level reviews, allowing approvals to be automated and rendered within hours
  • Automatic routing of complicated requests to a Conduent utilization review nurse for intervention
  • Automated non-certifications directed straight to clinical peer reviewers, providing time for peer-to-peer communication and culminating with the ultimate goal of approving or modifying care
  • Process savings of both time and expense, but most importantly the injured worker’s care is front and center in the process

 Strataware® Clinical Peer Review

Conduent provides clinical peer services to the workers compensation, auto casualty, and disability group health markets. In-depth evaluations of medical necessity are conducted by our panel of physicians who are board-certified in their respective specialties.

A peer review involves an extensive review of the requester’s questions, associated medical records and other clinical information. Special focus is given to pre-existing conditions, compensability, causality, and other relevant factors. Conduent delivers reliable decisions that are consistent with relevant standards of care and free of conflicts of interest.

  • Initial and appeal certifications
  • Complex medical records file reviews
  • Clinical, disability and return-to-work consultations
  • Impairment ratings
  • Physician peer-to-peer