Licensed nurses and board certified physicians ensure optimal outcomes
Stop Unnecessary Expenses
Proactive management reduces the costs that come from sub-par and reactive treatment plans
Data-driven plans based on medical evidence help you manage claims from initiation to resolution
Full Suite of Utilization Services
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Physician / Peer Review
What our customers are saying
"Ethos has been a valuable business partner going on six years now. Their timeliness and accuracy are a big part of our high-performer status."
Steve K.Director of Claims
"Ethos has been a great partner that makes our team more effective and significantly impacts claim outcomes."
MikeVP of Claims
"My non-represented file that could have turned ugly…returned to work on modified duty yesterday after having surgery. Ethos really helped out and together as a team we kept him from litigation and kept his claim cost low."
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If you need more information, please reach out and we’ll be happy to answer any of your questions.
What is Workers’ Compensation Utilization Review (UR) and why is it used?
Simply put, UR is a way for employers and/or claims administrators to determine if an injured worker’s proposed, ongoing or previously provided medical service, treatment or prescription medication is medically necessary. This is accomplished by comparing the clinical facts of the case against specific evidence-based treatment guidelines or criteria.
Can Utilization Review be used in all states?
Utilization Review is mandatory in some states and generally can be used in most other non-mandated jurisdictions when there is a medical necessity question associated with a proposed, ongoing or provided medical treatment or service.
Can medical treatment be managed under Utilization Review?
The process of Utilization Review focuses on ensuring that only appropriate and medically necessary care is approved. When medical necessity is questionable, the case is referred to an appropriately licensed medical professional for review and final medical necessity determination. Identification of unnecessary medical treatments or services provides an opportunity for the claims examiner to verify that the medical course meets accepted treatment guideline criteria, promoting optimal injured worker recovery and earlier claim resolution.
Is Utilization Review the same as a Peer Review?
No. A medical Peer Review typically involves a full medical record review with specific issues to be addressed ranging from compensability, extent of injury, future treatment, and/or return-to-work. Utilization Review is specific to the question of medical necessity only associated with a proposed, ongoing or provided medical service or treatment.
Don’t Get Stuck Paying More
Utilization management keeps you compliant, saves you unnecessary costs, and gets injured workers the care they really need. Don't risk losing more time and money, talk to us today.