Utilization & Treatment Review Services

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:

  • 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 two 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.