Request for Quick Review

REOH provides expedient Quick Review services for the industries of workers’ compensation, auto, liability, and group health. File reviews use an evidence-based approach and can uncover excessive treatment and expenses pertaining to a claim. Examples of cases that would benefit from a file review are questions pertaining to causation, medication usage/costs, and/or appropriate treatment/over-utilization. A REOH physician will objectively review a limited record set and provide guidance. Learn more about Quick Reviews.

Turnaround time is a maximum of four business days from medical record submission.

Name of person requesting file review

Name of surety responsible for claim

Claimant's name

Date of birth

YYYY

Gender

Female

Male

Claim or file number

Date of injury or claim

YYYY

Body part(s) to be addressed

Body part(s) that have been accepted

History of present illness

What will this file review be addressing? You may include up to three questions total:

List all claim-related and non-claim-related diagnoses. (Please include the FROI if this question is selected).

Is further medical treatment warranted? Outline treatment recommendations for the claim related conditions.

Is the individual's current treatment consistent with the Montana Utilization and Treatment Guidelines?

Any other question you would like addressed:

Limited to 3 additional questions

Date you have submitted this file review form

YYYY

What is your preferred method of contact regarding this referral?

Pages of records you are submitting

How will you be submitting the records?

Email (lcm@reoh.com)

Fax (406) 552-0401

All questions with an asterisk (*) are required fields.

REOH will contact you within 24 hours during the work week (with the exception of office closures) with confirmation that your submission and records were received.