Paladin's Utilization Review service improves on the standard industry approach in two ways: We use in-house physicians to conduct all utilization reviews, and we emphasize collaboration with treating physicians to lower appeal rates. Historically, the training and experience of our reviewing physicians have substantially reduced unnecessary and inappropriate medical treatment to help improve patient care.
Paladin's physician-guided utilization reviews earned us accreditation from URAC1, the health care industry's largest accrediting body, just two years after we introduced the service. Our utilization reviews also meet or exceed the accreditation standards of both California and Texas, two of the toughest accrediting states for managed care services.
Integration with Medical Bill Reviews: We further improve upon the industry norm by integrating our utilization and bill review platforms. Specifically, utilization review results are transferred electronically to our bill review system, which automatically ensures that our clients pay only for medical services approved by Paladin's physicians.
- Physician review of all medical treatment plans
- Ongoing physician review of medical services and procedures during treatment and follow-up
- Collaboration with treating physicians to ensure the most appropriate treatment for the patient
- Peer review of physician recommendations, as necessary
- Integration with Paladin's medical bill review system to ensure that only approved services are paid for
1 URAC standards are developed by a committee of experts representing diverse interests in the health care community: providers, health care organizations, insurers, and the public interest. When new standards are developed, experts from that particular area of health care delivery participate on the committee. URAC always circulates draft standards for public comment so that anyone can have input in the standards development process.