Guides for Payers

When are Bone Growth Stimulators Medically Necessary?

This white paper was developed to assist in the determining of medical necessity of bone growth stimulators and the highlight the increase in off-label uses.

When is Orthognathic Surgery Medically Necessary?

This white paper provides an overview of orthognathic surgical procedures, including Le Fort I osteotomy. It also covers how to on determine the medical necessity of orthognathic surgery.

Polypharmacy and Off-Label Drug Use

This white paper discusses issues related to polypharmacy and off-label drug use in psychiatric care.

When is Pediatric Behavioral Development Medically Necessary

This white paper focuses on pediatric developmental behavioral health services and the latest approaches to evaluating and treating speech disorders and sensory integration disorders.

Oncology Management White Paper

In this white paper AllMed highlights the advances in diagnostic nuclear medicine and molecular imaging for cancer management.

Botox White Paper

This white paper highlights the importance of keeping up-to-date with the most recent indications and off-label uses for Botox, as well as the potential side effects associated with both cosmetic and medical uses of Botox.

Pediatric Growth Hormone White Paper

In this white paper from AllMed we focused on helping you understand the medical necessity of associated with the use of pediatric growth hormones, as well as the importance of proper identification of growth hormone deficiencies.

Varicose Veins White Paper

In this white paper you will learn about the different types of procedures for treating varicose veins, including conservative techniques and procedures considered either medically necessary or cosmetic.

Spinal Fusion White Paper

This white paper highlights the increased use of spinal fusions to treat lower back pain and the current state of artificial disc replacement surgery.

Radiation Oncology Tech Advacements

This white paper covers how the ongoing innovations in radiation therapy present the challenge for healthcare policy-makers and providers to develop the most effective, efficient and safe treatments for patients, as well as to integrate these innovations into routine practice, guidelines and coverage.

How to Interpret the New Internal and External Appeals Regulations White Paper

Before hastily interpreting the new provisions of Section 2719 of the Patient Protection and Affordable Care Act and implementing new processes that may not be necessary, payer organizations should realize that most of them will generally be compliant with their existing internal appeals process and will not need to make any changes.

Busines Case White Paper

This white paper highlights what health plans, TPAs and medical management organizations are going through as they consider outsourcing first-level physician review in order to reduce fixed costs.

Identifying and Reducing Overutilization of Epidural Steroid Injections

The Cutting Edge, Clinical Updates for Claims and Medical Management Professionals.

Download The Cutting Edge Medical Management GuideDesigned as a clinical update for Claims and Utilization Review Professionals this guide is geared to inform them on the latest treatments, hot topics, and their medical necessity.

Designed as a clinical update for Claims and Utilization Review Professionals this guide is geared to inform them on the latest treatments, hot topics, and their medical necessity.

Medical Review Standards Guide

Download this guide and learn how to improve the quality and consistency of medical review determinations.

Utilization Review Guide

Sorting Out the Patient Care Puzzle: The Role of IROs and Medical Management Companies

The Cutting Edge V2I2 Oncology Edition

Designed as a clinical update for Claims and Utilization Review Professionals this guide is geared to inform them on the latest treatments, hot topics, and their medical necessity.

The Cutting Edge V2I1

Designed as a clinical update for Claims and Utilization Review Professionals this guide is geared to inform them on the latest treatments, hot topics, and their medical necessity.

The Cutting Edge V1I1

Designed as a clinical update for Claims and Utilization Review Professionals this guide is geared to inform them on the latest treatments, hot topics, and their medical necessity.