Services
PEER REVIEW / UTILIZATION REVIEW / CONCURRENT REVIEW
Medically Defensible Opinions for Utilization Management and Claims Adjudication
- In the complex landscape of healthcare claims, achieving clinical integrity and controlling medical spend requires expert, unbiased review. CUBEXLE partners with insurance carriers, Third-Party Administrators (TPAs), and managed care organizations to provide superior Peer Review and Utilization Review (UR) services, ensuring care aligns with the highest standards of medical necessity and evidence-based medicine.
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Our nationwide network of active, board-certified physician reviewers offers
specialty-matched expertise, delivering clear, authoritative, and medically defensible opinions for complex claims and treatment authorization requests across all lines of business.
500
Clients Served
100
Client Satisfaction
Comprehensive Utilization Review (UR) Services
Utilization Review (or Utilization Management) is a critical process for evaluating the appropriateness, efficiency, and quality of healthcare services. CUBEXLE provides comprehensive UR across the full continuum of care, supporting you in
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Review Type
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Timing
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Key Function For Claims Management
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Prospective Review
(Pre-Certification) |
Before treatment begins
(Prior Authorization) |
Determines Medical Necessity and Appropriateness of Treatment prior to a service being rendered, preventing unnecessary costs.
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Concurrent Review
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While the patient is actively receiving care (e.g., inpatient stay)
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Monitors continued Medical Necessity, length of stay, level of care, and supports timely discharge planning and care coordination.
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Retrospective Review
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After services have been delivered and billed
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Validates the appropriateness of care post-service, assisting with claims denials, appeals, and cost recovery.
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CUBEXLE's Independent Peer Review Expertise
Our physician-level peer review extends beyond standard UR to address the most challenging claim scenarios, ensuring a specialist-to-specialist discussion on complex cases or provider appeals. Every review is delivered as a comprehensive, evidence-based report that addresses your specific questions, including
Key Areas of Clinical & Legal Analysis
- Medical Necessity and Appropriateness of Care/Treatment
- Causation and relatedness of injury or illness
- Standard of Care review
- Experimental/Investigational treatment determinations
- Evaluation of Diagnosis and treatment plan
- Review of Over-utilization and potential fraud/abuse concerns
- Determination of permanent Restrictions and Limitations
- Assessment of Return-to-Work capability and Level of Impairment