Comprehensive Clinical & Utilization Reviews

medlitix has a panel of over 100 different medical and allied health specialties that provide expert-level utilization, initial and appeal reviews. Our clients are provided with state, license, specialty, and sub-specialty matches to ensure the most comprehensive and request-specific reports available. Our services include:

• Prior Authorization – Full spectrum of utilization review services, including prior authorizations for procedures, medications, and pre-certifications.  
• Physician Generalist Reviews – Ensure proper utilization through independent physician-level reviews.  
• Quality of Care or Specialist Physician Reviews – Identify specialty specific opportunities for improved patient outcomes. Specialties include Behavioral Health, Cardiology, Radiology, Orthopedics, Genetics, Oncology, and several others.  

• Independent Appeals – First and Second level appeals delivering objective clinical assessments to ensure fair and accurate determinations.  
• Federal & State External Reviews – Expert evidence-based guidance through regulatory appeals processes.  

• SIU – Uncovering fraud, waste, and abuse in healthcare claims.  
• DRG Clinical Validation – Ensuring accurate Diagnosis-Related Group (DRG) coding and reimbursement.  
• Pharmacy Reviews – Evaluating medication use for safety, efficacy, and cost-effectiveness.  
• Gold Card Solutions – Bypass prior authorization requirements based on demonstrated history of delivering consistent high-quality, evidence-based care.  

Conducted by a team of physicians, pharmacists, and nurse experts, medlitix’s reviews are delivered with timely turnaround times (TATs) and exceptional quality—empowering Health Plans, TPAs, Self-Insured and Government employers with timely, data-driven decisions and their patients with the highest level of quality outcomes.