Request for Utilization & Treatment Review
REOH provides expedient Utilization & Treatment 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/overutilization. A REOH physician will objectively review a maximum number of 25 pages of medical records and provide guidance.
REOH’s Utilization & Treatment Reviews are beneficial when one or more of the following exist:
Causation Assessment needed
Excessive claim costs
More than reasonable number of visits to the same provider with no functional improvement
Questionable relatedness of treatment to a specific claim
Questionable reasonableness of treatment
Potential pharmacy overutilization
Aggravated or exacerbated pre-existing condition(s)
Catastrophic or permanent injuries
Frequent specialty consultations/diagnostic testing with no definitive diagnosis
Establishing causation in cases of delay in reporting an injury or delay in seeking treatment for a specific claim
Lack of medical documentation or evidence-based treatment plan
Turnaround time is a maximum of four business days from medical record submission.
To ensure that reviews are based on the best evidence-based information available, REOH uses legally defensible guidelines (found here).
REOH cannot review files regarding: Medicare supplement, disability income, hospital indemnity, specified accident, credit, long term care, and non-governmental self-funded plans.
All questions with an asterisk (*) are required fields.
After submitting this form, please fax records to 833-734-REOH (7364) or email to Leah, at firstname.lastname@example.org. We’re happy to help if you have questions about what records to send, feel free to contact Leah with questions.
REOH will contact you within 24 hours during the work week (with the exception of office closures) with confirmation your submission and records were received.