An administrative review conducted by health care professionals to determine the appropriateness of proposed medical care.  This process is clinically sound and respects patients' and providers' rights

The Medical Society Medical Review Foundation (MSMRF) provides utilization review services for ProviDRs Care Network.

The MSMRF was incorporated in 1983.  Registered Nurses (RN's) with over 50 years of clinical experience and more than 30 years of utilization review experience comprise the MSMRF staff.  All RN's are certified by the American Board of Managed Care Nursing.  The MSMRF staff also consists of a physician Medical Director and physician Medical Advisor.  Six additional physician advisors, two of whom are psychiatrists, complete the medical management team.  The MSMRF has been accredited by the Utilization Review Accreditation Committee since 1992.

Utilization review services are conducted using Milliman Care Guidelines and include pre-certification for inpatient admissions, outpatient surgeries and diagnostics, concurrent review, skilled nursing admissions, point of service referrals, and discharge planning.  Clients that may benefit from case management are quickly identified by the MSMRF staff and a referral is made to the appropriate insurance carrier and/or third party administrator.