Preventing Overuse Of Medical Procedures
All outpatient procedures involve some level of risk, but MedCost’s Outpatient Review provides a safeguard by evaluating a member’s medical history during pre-certification to ensure that other, more conservative measures have been exhausted. The goal is to reduce the number of unnecessary surgical procedures and diagnostic tests while keeping the member’s health and safety a top priority.
Program Options To Suit Clients’ Needs
MedCost offers two program options:
- The Comprehensive Outpatient Review program requires calling MedCost for any outpatient procedure performed outside of a physician’s office, including varicose vein treatment and MRI, CT, and PET scans.
- The Diagnostic Review program requires participants to call MedCost for certification for specific diagnostic procedures that have been identified as frequently overutilized, such as MRI, CT, and PET scans.
Nationally Recognized Criteria Used In Review Process
Our experienced team of registered nurses, under the supervision of our Medical Director, uses evidence-based, nationally recognized guidelines to evaluate appropriate standards of treatment for a given condition. MedCost also maintains a review panel of more than 70 physician consultants who are board certified and currently practicing in a wide variety of specialties.
Accredited By URAC
The MedCost Utilization Management program is URAC accredited, which assures members and clients of our compliance to federal and state standards for review procedures. URAC is a well-known, independent organization that validates a company’s accountability and commitment to quality.