Company Info For Members For Employers For Agents For Providers Provider Directory


Home


365 Well Street


Case Management


Certificate of Coverage


Complaints


Concurrent Review


Confidentiality


Customer Service


Directory Update


Disease Management


Fraud And Abuse


Member Handbooks


Member Introduction


Member Packet Portal


Notification


Pharmacy


Preventive Guidelines


Printable Forms


Quality Standards


Rights And Responsibilities


Retrospective Review


Utilization Review


Web Links

For Members

Retrospective Review

Retrospective review is the process of reviewing coverage requests:
  • After the service has been provided, or
  • When the member is no longer an inpatient or receiving the service.
    • A review initiated while a member is hospitalized is considered a concurrent review.
    • A review as the result of a notification or claim denial is considered an appeal.