Utilization Review and Peer Review

Conduent's URAC accredited utilization management services seamlessly integrate with Strataware® medical bill review.

Accelerate Quality Medical Care

By assessing care appropriateness before health care is provided using evidence-based criteria or guidelines, utilization management can help ensure effective provision of care. Conduent provides utilization management services for injury and accident claims. We offer a URAC-accredited program seamlessly integrated with case management, medical bill review and medication management to deliver an integrated and exceptional experience that reduces costs while increasing quality outcomes.

Stratacare® Utilization Review

Our utilization review solution for Strataware® medical bill review software and service customers can be integrated with any claims management platform. Stratacare 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

 Stratacare® 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