Auto Claims Review

Overview

These clinical reviews are conducted to address excessive and even fraudulent medical treatment related to auto liability BI (bodily injury) and PIP (personal injury protection) claims. This is especially true for low-impact accidents with soft-tissue damage, a nationwide issue. The nuances of each jurisdiction (strategies used by claimants to take advantage of the “system” and tools the state allows) are taken into account.

For PIP/MedPay claims, PRIUM ensures appropriate medical services and billing. For BI claims, PRIUM mitigates exposure for what should be paid.

The Program

The purpose of this program is to establish boundaries for treatment that are reasonable, necessary and related to the accident. These conclusions are drawn from the statutes of limitation enforced by each individual jurisdiction. The program focuses on the following components:

• Early engagement with the treatment provider to proactively establish a reasonable treatment plan. 
• Works with the treatment provider(s) to complete the treatment. 
• Leverages Evidence-Based Medicine (EBM) as best practice for treatment scope. 
• Establishes a sentinel effect for ongoing treatment. 
• Identifies up-coding, un-bundling and excessive fee billing practices. 
• Replaces the need for an IME (Independent Medical Exam).