MedCert First-level Utilization Reviews

MedCert is AllMed’s medical review solution for health plans seeking a partner to take on some or all of their utilization management operations. With MedCert, health plans and medical management organizations can easily offload physician review and utilization management to AllMed, increasing their capacity and flexibility while containing costs.

It is not uncommon for Medical Directors to review 50 or more cases per day, and the volume of reviews to be performed on top of other duties can be overwhelming. This can lead to burnout and turnover and directly impact both quality and cost.

That’s why payers are increasingly looking to optimize the work of their Medical Directors by focusing them on strategic initiatives, such as medical policy and plan language development, quality program oversight, and other higher value-added tasks. By offloading physician prior authorization reviews to AllMed, you can focus your scarce Medical Director resources on other programs and initiatives.

MedCert Offers:

• Nurse review/preparation of incoming Utilization Review prior authorization and concurrent review requests, and routing of appropriate cases to AllMed physicians for review
• Physician review of cases that do not meet medical policy, plan language, or standard of care criteria
• Communication of determinations to members (coming soon)

Each MedCert review determination is a simple “certify” or “non-certify” determination with an easy-to-read, abbreviated rationale. MedCert is deployed through PeerPoint®, AllMed’s advanced medical review portal. This allows you to send, track, and receive cases electronically while meeting the highest information security standards.

Customized Reviews from AllMed

AllMed partners with your team to provide utilization management (UM) solutions. We tailor our process to your specific needs and ensure review quality and integrity while controlling overutilization to:

• Streamline your organizational processes to reduce review expenses
• Optimize medical directors’ time to allow focus on higher-value work
• Handle fluctuating caseload volumes to lower your fixed costs