Preferred Utilization Management, Inc. (PUMI) utilization review services can be employed in several ways.

PUMI strives to maintain flexibility in our review systems, allowing us to meet the particular needs of each client. Following are a few options available to PUMI clients. All of these options can be modified to meet your chiropractic review needs. PUMI health utilization management services have been fully accredited by URAC.

Retrospective Review:

You can submit selected cases to PUMI for review. Cases are usually selected for review due to unusual treatment patterns or diagnoses by a treating provider. PUMI provides the client and, if requested, the provider with review decisions regarding appropriate duration and types of treatment or suggests referral to a more appropriate provider for the patients' condition.

Concurrent Review/Treatment Authorization:

Concurrent review is used for a more controlled insurance plan. Providers will submit Initial Reports to PUMI within five days of first date of service. PUMI will approve, modify or deny the proposed treatment plan and inform the client, provider, and if appropriate, the patient of the review decision. This option is typically used by health plans that cover only authorized services.

Under this option, the treating chiropractor is given a three visit corridor to allow time for submission of Initial Reports and return of authorization from PUMI. We suggest that the client require treating chiropractors to submit reports within no more than five (5) days of the initial examination. PUMI processes authorization requests within 24 hours. This program can be tailored for workers' compensation where state laws allow.

Internet Based Review Services:

Your utilization review or claims staff will soon be able to access the PUMI software through uploading HIPAA compliant files (278 and 837) to our server. Our system will automatically process the authorization requests and provide an electronic authorization response for each file that can be downloaded to your claims system. Using the PUMI software will provide unmatched chiropractic expertise to your review staff. Furthermore if you are using reviewing professionals, the PUMI software will provide an extra dimension of consistency and credibility to review decisions.

Complete Managed Care Services:

PUMI's owners also own chiropractic networks in 48 states. By combining our review services with our highly credentialed provider network, you can assure maximum savings and quality of care. We have the systems to provide a complete chiropractic carve out, allowing clients to transfer the financial risk of chiropractic care. Our carve-out has saved clients as much as 73%.