Initial Physician Reviews

As an Independent Review Organization (IRO), our physicians can serve as an extension of your team to provide initial review services. We can provide prior authorizations, concurrent reviews, and continuation of care reviews for our clients. 

Our review capabilities include:

  • Inpatient/obs determinations 
  • Outpatient services
  • Inpatient services
  • Home health
  • Imaging 
  • DME
  • Inpatient rehab
  • LTAC
  • Part B Pharmacy/Chemotherapy
  • Genetic testing and pharmacogenomics

Because of our deep understanding of Medicare regulations and the hierarchy of criteria, our initial review services are ideal for Medicare Advantage plans. Our physicians can also provide criteria-based reviews for commercial health plans, government health plans, third-party administrators, and stop-loss insurers.

When to use our Initial Physician Reviews

  • Increased Volume
    Relieve bottlenecks in reviews due to changing enrollment numbers or unpredictable increases in review volume.
  • Service-line Focus
    Harness unbiased and evidence-based perspectives for your costly service lines to improve utilization and reduce costs.
  • Complex Reviews
    Access additional insight and expertise for your complex reviews, enabling your staff to focus on other strategic priorities.
  • New Technologies and Treatments
    Confidently process reviews for new procedures and technologies.  
  • Staffing Shortages
    Extend your team during temporary staffing shortages without compromising quality and service.

How Cadenza can help with your Initial Reviews

  • Insight
    Allow your medical directors to focus on strategic priorities by outsourcing their burdensome reviews without sacrificing quality. Our physician reviewers are truly independent reviewers who can be trusted to consistently provide impartial and unbiased criteria-based reviews, regardless of your regulatory environment.
  • Expertise
    Our physicians have a depth of experience across a number of service lines and specialties in the strictest regulatory environments. For all of our reviews, we not only know what to look for but also how to apply the necessary criteria to develop appropriate determinations for each case. We can also provide a detailed rationale for each determination.
  • Responsiveness
    Our team has developed processes to eliminate delays to ensure that the reviews we deliver are efficient and accurate, every time. We can work within your tight turnaround times to ensure compliance, even when review volume is high.
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