Utilization Review

Patriot’s experienced registered nurses review medical treatment requests using medically accepted clinical review criteria to validate medical necessity and appropriateness of a treatment plan.

Utilization Review provides the claims professional with a prospective, concurrent or retrospective review of the medical necessity for services requested. A registered nurse completes a first level review based on national evidence-based guidelines, and if indicated, will coordinate reviews with a physician advisor when such guidelines are exceeded or unmet.