1010 E. Union St. Suite 203, Pasadena, CA 91106 P: (866) 808-GSGA
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Utilization Review Overview

GSG’s Utilization Review program has shown outstanding results and great satisfaction for all of our clients. GSG saves you money on the cost of UR services while reducing your medical expenses and minimizing your exposure to penalties through a collaborative approach to Utilization Review and/or Utilization Management.

When one examines Utilization Review at its basic level, it is actually a very simple process: does the treatment request match established and/ or accepted peer reviewed medical guidelines?

What sets one vendor apart from the other is the philosophy with which they approach the function of Utilization Review:

  • Do their Nurses and Physicians collaborate and negotiate with treating physicians to develop a treatment plan that is the most appropriate for the injured worker, or do they evaluate each treatment request in a vacuum?

  • Do they offer to utilize different strategies to help clients manage their costs and stay in-line with regulatory requirements?

  • Do they come from a perspective that they need to deny care in order to show a savings? Or do they see the bigger picture and understand that expeditious treatment will lead to better outcomes for the employee and employer in the long-run?

This emphasis on denials has other downsides for clients:

Many UR vendors utilize their Nurses as “Loss-Leaders,” pricing their Nurse services at a loss; utilizing the nurses to “feed” reviews to their UR Doctors at a much higher rate.

Rather than attempting to evaluate or negotiate a treatment plan that on first-glance does not meet guidelines, the nurses immediately transfer the request to their Physician Advisor – whose charges are much higher than the nurses.

GSG does not believe in this model. Our price per nurse review may be higher than you are quoted by other vendors, but your total cost for the UR program will invariably be lower, please see the price comparison for additional details.

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Further, this emphasis on denials may ultimately lead to increased costs for clients; are treatment denials and delays keeping your injured worker from achieving Maximum Medical Improvement and returning to work as quickly as possible?

GSG can also bring a proactive approach to Utilization Management within the framework of UR:

  • GSG works with many of our clients to bring a pro-active perspective to the medical management of the injured employee. When the nurse receives a treatment request or an injury that would indicate future treatment would be required, rather than evaluate only the initial treatment request, the nurse reaches out to the provider to discuss the treatment plan as a continuum. Thus, when future treatment requests are submitted from the provider it will usually have already been discussed with our Nurse or Physician and agreed upon, and a quick approval is given expediting treatment and maintaining regulatory compliance.

  • We ensure that the injured employee should receive the appropriate care from the appropriate provider at the appropriate time.

  • By bringing this philosophy to our Utilization Review services, we save our clients on their claims costs by expediting quality care and establishing good will with providers of care.

The GSG approach not only saves our clients money on the cost of review services, it also mitigates unnecessary treatment without putting an emphasis on denials while building a more cooperative relationship with treating providers and saving time in getting treatment so the employee can achieve Maximum Medical Improvement and return to work more quickly.

For detailed information, please view our Utilization Review Plan byclicking here.

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