Learn more about AFMC Review Services
Utilization review services
Helping providers meet quality standards of care
AFMC’s Fort Smith office provides health utilization management reviews for public and private health plans to ensure all health care services reimbursed are provided in the most efficient manner and are medically necessary. Review staff also helps providers deliver the highest quality of care while at the same time preventing fraud and abuse. Services include:
- Utilization review – evaluation of the appropriateness and medical need of health care services and procedures according to evidence-based criteria or guidelines, and under the provisions of an applicable health benefits plan
- Retrospective review – validation of insurance claims against the medical records after services have been performed
- Prior authorization – determination of whether a service is medically necessary prior to delivery
- Specialty physician reviewers for review of complex coding and billing issues, disputed denials, and development of criteria for new medical and surgical treatments and procedures
- Workman’s compensation claim review
- Quality of care review
- On-site clinic certifications to ensure proper staff credentials and adherence to all applicable laws and regulations
- Education and technical assistance to providers regarding review submissions and quality improvement plans
Be sure to visit our health utilization management review page.
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