P&S Network offers the highest quality of Peer Reviews, UR Determinations, Independent Medical Reviews, and CIA/IA Auditing services. All our services are overseen by board-certified physicians. Our Physicians, Physician Assistants, and Registered Nurses are highly experienced, US based, and fully credentialed
Independent medical peer review services are at the core of our business. We understand that the rising cost of healthcare affects everyone, thus the purpose of these reviews is to help keep health care costs down and ensure that patients receive the appropriate medical treatment. P&S Network currently offers IRO services for multiple states and insurance companies. The IRO process helps avoid unnecessary repetitive appeals and provides a conflict-free determination performed by specialty-matched board-certified physicians, which can then be utilized to resolve medical treatment disputes.
P&S Network provides a highly customizable Utilization Management solution. Our credentialed, US-based Nurses follow ODG, ACOEM, or/and any other state-specific guidelines in conjunction with thoroughly analyzing the subjective and objective outcomes in each case as well as the specific medical policies of the carrier, to determine if the requested procedure is medically necessary or appropriate. The P&S Network Level I healthcare professionals interact with requesting physicians and claimants to evaluate medical necessity. Our advantage lies in our integrated technology solution, Smart UR Flow (SURF), which ensures the highest compliance and quality standards as the request goes through various stages of determination. Additionally, our Level I Nurses have access to our board-certified Physicians to deliver the highest quality of determinations.
Peer Reviews (Level II)
Since 2003, P&S Network has provided high-quality peer reviews at competitive prices for carriers, third party administrators, utilization review organizations, and employers. Our difference is that we offer a single point of contact, accessible during business hours for all time zones within the U.S. Our staff are knowledgeable and can accommodate your specifications for the report. We ensure excellent reports and fast turn-around times. We offer the next day turn around to help you meet your demanding deadlines and same-day stat reporting is also available on an as-needed basis. We also have an extensive panel of physicians, all of whom are board-certified in their respective specialties. We offer state matching when required or requested.
Pharmacy and Medications
P&S Network is one of the pioneers in the use of high-cost prescription drugs in Workers’ Compensation and executing innovative solutions to ensure the safe and cost-effective use of medications. With our extensive knowledge of evidence-based pain management, we work with treating physicians to assist them in discontinuing patients from risky levels of opioids/narcotics. Your costs are reduced when we identify drugs that should not be billed through workers comp and obtain agreements from providers to substitute generics for expensive brand name drugs. You will receive a report that includes the agreements reached in the peer to peer call, a clinical summary, and recommendations for future use of medications
P&S Network is an approved IRO by the Office of Inspector General (OIG). We conduct comprehensive reviews of claims submitted to and reimbursed by Medicare and Medicaid programs. We determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claims were correctly coded, billed, and reimbursed. We also conduct independent reviews specific to the requirements listed in the CIA/IA to ensure full compliance.
MMI impairment ratings issued by the Treating Physician or Medical Legal Consultant (IME, AME, QME) are oftentimes inaccurate, resulting in a potential settlement that does not reflect the injured workers’ true disability. We offer the opportunity to obtain an Independent Impairment Rating performed by a certified impairment rating specialist in order to allow the claims examiner the ability to challenge the original rating through deposition or by other means.