ATHENS eBULLETIN | December 30, 2019

Earlier this year the Department of Industrial Relations (DIR) and it’s Division of Workers Compensation (DWC) discussed the progress they’ve seen on the Department’s Independent Medical Review (IMR) program. An IMR is the dispute resolution process put together by the state’s workers’ compensation system. It is a panel of medical professionals who review decisions made by the insurance program.

As the use of Independent Medical Reviews continues to increase, we are seeing a steady decrease in the turnaround time. Overall, the industry is seeing Maximus Federal Services, Inc., (the IMR organization administering the program) overturn denial decisions at 10.33%. Contrary to industry standards, Athens Managed Care (AMC) has seen an overturn rate of only 1.14% and has found that the IMR program has not had a negative effect on the Utilization Review process confirming that Athens Managed Care is making appropriate, evidence based decisions that stand up to dispute challenges.
Of our 2018 completed reviews, Athens Managed Care had the following:
  • Decisions Overturned – 1.14%
  • Decisions Partially Overturned – 0.80%
  • Decisions Upheld – 7.26%

*this information is based on all 2018 completed decisions, not just denial or mods.

For specific questions regarding Athens’ UR processes please contact Leann Farlander.

Founded in 1976, Athens Administrators delivers superior workers’ compensation and liability claims administration services and support with the highest level of personalized attention. We are a full service, customer-centered organization dedicated to creating value and delivering results.

 

For further information on Athens Managed Care services please contact:

LEANN FARLANDER
Cost Containment Director | Athens Managed Care
949.296.3961