CASE MANAGEMENT
VOCATIONAL/RTW
PREAUTHORIZATION
>PEER REVIEW
MEDICAL BILL REVIEW
LIFE CARE PLANNING
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ARK. COMP LAW
ARK. COMP RULES

Professional File Review Services
Our Professional File Review services provide valuable assistance in addressing your claims issues. We offer two types of file review tailored to your claims needs.

1. RN Review:  In our nurse review, we organize and analyze the documentation in your file and provide a chronological summary of the medical data and treatment history. We also pinpoint any issues pertinent to a claim settlement and provide corresponding recommendations to address them.

2. Physician Review:  To provide a more authoritative and objective opinion, we can arrange a specialty-matched physician peer review to:

• Substantiate accident relatedness of conditions

• Assess medical necessity and relatedness of treatment

• Clarify status of maximum medical recovery

• Predict likelihood of further treatment expense

• Evaluate whether work disability is supported medically

• Address other claim issues falling within the scope of a physician's knowledge and expertise

The physician peer review is coordinated by a Systemedic registered nurse who prepares the file and refers it to an independent peer review service provider (Arkansas UR certified).

For additional information or a free consultation, contact: Evonne Nusz, Manager, RN, CCM
Phone: 501-227-5553 or 800-822-2680 (ext. 139)
Fax: 501-978-2050

Use this link if you would like to refer a case to Systemedic.

Summary of Arkansas workers' comp regulations pertaining to peer review programs
In Arkansas workers' comp, peer review is a means of obtaining an independent, specialty-matched medical opinion based on review of medical records. A peer review documents an opinion, which is only one of several factors that can be considered in a claims decision regarding payment, eligibility or treatment issues made by an insurance carrier, TPA or employer.

AWCC Rule 30 requires preauthorization review services to be conducted by an entity holding current Utilization Review (UR) certification with the Arkansas Department of Health. Under this certification, physician peer review is a required step in the review process, prior to any non-approval of a treatment determination.

Rule 30 also allows for physician level review of issues other than preauthorization, as part of the professional review component of the required utilization review program. AWCC Rule 33 further emphasizes the importance of this service by requiring a "medical peer review program" as part of the Quality Assurance Program of an AWCC certified MCO.

Important alert: Written documentation of any non-approval/non-payment decision made by the insurance carrier, TPA or employer, based on a peer review opinion, must be sent to the medical care provider(s) involved, with the rationale for the decision and with required notification of appeal rights as mandated in Rules 30 and 33.