The treating clinician who participates in the UR process should expect the reviewing clinician to be courteous, straightforward, and professional. Clinical decisions made by reviewing clinicians should be prompt and should also accompany a clearly stated procedure for appeal. For example, after ChiroView receives the requested clinical documentation, typically via fax, response is provided in most cases within 24 hours to all parties, including the treating clinician. One of the most crucial elements in the UR process is the ability to implement a fair and timely appeal procedure. The appeal process must be initiated in writing and, if appropriate in some cases, followed by telephone conversation.
Most state regulations allow for a period of up to four weeks to respond to any appeal.
I believe this to be unacceptable. Certainly, appeals can be handled in more timely fashion. The Managed Care Arena I am greatly concerned about the many types of contractual agreements treating clinicians have entered into with various managed care organizations. Specific to chiropractors, I am already observing a strong backlash. In listening to many treating clinicians, several issues of concern include a continuing poor access to patients, grossly reduced reimbursement schedules, a lengthy process required to obtain treatment authorization, and difficulty in receiving authorization in timely fashion.