Utilization Review

Focusing on medical necessity and reasonable treatment.

Kunkel Care Solutions Utilization Review focuses on medical necessity and reasonable treatment. Our team of registered nurses and panel of certified peer reviewers use nationally recognized guidelines and treatment protocols to pre-certify appropriate treatment.

Through our utilization review, we can ensure the medical care received by members is appropriate and medically necessary. This leads to better outcomes for the member and maximizes plan savings.

Services include:

  • Pre-certification of services including but not limited to: Inpatient Stays, Outpatient Procedures, MRI/CT/PET Scans, Durable Medical Equipment (DME), Therapies, and Second Opinion Coordination
  • Concurrent Review
  • Peer Review
  • Referrals to Case Management
  • Proactively educate and direct members to plan cost containment programs prior to services rendered.

Disclaimer: Statements on this website as to policies and coverages provide general information only. All coverages are subject to terms, conditions and exclusions of the actual policy issued.

Interested inUtilization Review?