PDF Service Request
Peer Review -
File Review with a written report on medical necessity, reasonableness and relatedness of care by a Peer Physician. When applicable, the Demand Letter is addressed.
Diagnostic Test Review -
Review & Report by Peer Physician of Diagnostic Test impressions/results and “Raw Data” (i.e. films, waveforms/graphs etc).
(Independent Medical Examination) – File Review and a hands-on physical examination with a written report.
(Impairment Rating Review) – File Review with a written report on the accuracy of the Impairment Rating.
(Required Documentation Request) - A written report/chart of missing records, documentation and/or billing to request from each provider/facility.
(see “Scanning Request” form)
PDF Scanning Request