The objective of Align Networks' clinical review process is to monitor therapy utilization
through peer to peer communication that identifies lack of progress or compliance
for each case managed by Align Networks, providing both quality and cost monitoring
for our customers.
At the time of referral, workers’ compensation-specific guidelines* are used to
establish a visit count guideline based on the specific injury and create a systematic
clinical trigger for each referral.
The provider is advised of the visits count guidelines at the time of initial referral.
If a provider requests additional visits that will exceed the clinical guideline
trigger, then a courtesy clinical review is automatically initiated by Align Networks.
All providers are benchmarked against our visit guidelines* and on the percent of
cases reviewed to maintain preferred status in our network.
Clinical Review Recommendation
When a review is complete, a ‘Clinical Review Summary’ is completed, including the
reviewers clinical recommendation. Final authorization or denial is the decision
of the adjuster or case manager. Align Networks will also send the clinical report
to the doctor for review and revised orders as requested by payor.
Align Networks focuses on clinical outcomes. We track average number of visits per
episode of care and other clinical metrics to ensure superior outcomes and provider
management. The Align Networks clinical model ensures the most appropriate care
is delivered, optimizing return to work outcomes.
Align Networks’ clinical process gives payors the information needed to determine
when therapy is not working, preventing unnecessary utilization and costs. It also
allows for additional therapy to occur on individual cases where it is shown to
be clinically beneficial.
Contact Align Networks to get detailed clinical outcomes and savings report for
Email: Clinical Help
*Workers’ compensation-specific guidelines were developed in conjunction with the
Official Disability Guidelines (ODG), Medical Disability Advisor (MDA) and American
College of Occupational Environmental Medicine (ACOEM). Align Networks can incorporate
additional visit count guidelines or restrictions based on individual customer needs.