Services - Medical Necessity Consults - Case Management Specialists, Inc.

Return on Investment $11.04 for Medical Necessity Determinations*

Return on Investment $15.27 for Infertility Claim Reviews**

CMS will provide recommendations in regard to the medical necessity of services utilizing evidence-based criteria. Our infertility claims review nurses assist claims processors by making recommendations regarding medical appropriateness determinations, distinguishing diagnostic services from infertility treatment. Our expertise may lead to identifying appropriate options early in the review process that may assist with cost containment—without compromising quality care.

Our clinicians provide input on the following:

Durable medical equipment rental or purchases
Medications
Ambulance services
Outpatient treatments
Potentially cosmetic services
Negotiated costs with out-of-network providers
Access consultants for clarification of cases that are outliers to evidence based criteria
Infertility claim reviews

Sample Reports:

Continuous Passive Motion(CPM)Determination

Cosmetic Surgery Determination

Epidural Steroid Injections (ESI) Determination

Infertility Report

Virtual Colonoscopy

*ROI based on actual CMS book of business for 2009. 2008 Return on Investment - $10.93 **Return on Investment based on actual CMS book of business for 2006.