Concentra Physician Review

Providing prospective, concurrent, and retrospective reviews for medical necessity

Concentra's Physician Review program provides physician-based review services, which are defined in the industry as "the evaluation of medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities."

Our program services include the following:

The evaluation of the medical necessity of a requested treatment,
Physician-to-physician contact if denial determination is expected, and
A written report detailing the recommendation, physician contact, and peer-reviewed literature used in making the recommendation.

Our clients

Concentra's affiliated physicians primarily serve utilization review companies, insurance carriers, third-party administrators, and large self-insured employers. Our customers have the option to use our Utilization Review in conjunction with our Physician Review Services or as stand-alone program.

Affiliated physicians

Physicians participating in Concentra's review network undergo a credentialing process to meet state requirements. They are Board-certified, credentialed reviewers in active practice. Learn more about our network of physicians.

Our medical management model

Concentra employs a medical management model under the direction of a national medical director. This physician director provides oversight, quality assurance, and process management.

URAC Accreditation

Concentra Physician Review is accredited by URAC, a health care accrediting organization that establishes quality standards for the health care industry.