Comprehensive Clinical & Utilization Reviews
medlitix provides clinical and utilization reviews designed to help Health Plans, Third Party Administrators (TPAs), Self-Insured and Government entities ensure the highest level of quality care while managing healthcare costs.
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:
Utilization Management
- 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. Button for list of specialties (We should expand to over 100 specialties if we can). Short write up on our physician panel and underneath the list of specialties. I do not think we need the map.
Appeals
- 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.
Additional Services
- 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.