File Reviews & Consultations
File reviews are conducted by PsyBar’s diverse panel, composed of board certified physicians, psychiatrists, psychologists, neuropsychologists, non-psychiatric medical doctors and registered nurses. Our doctors are experts in addressing the complex areas of intersection that might clarify a claimant’s symptomatology when there are multiple, competing explanations for potential impairment. We perform file reviews for workers’ compensation, automobile accident and disability cases as well as return to work situations. File reviews allow for prompt and fair disposition of a claim and can be a valuable cost saving service.
- Medical Record File Review
PsyBar’s independent doctor, of equal specialty as the treating provider, reviews available medical records and responds to specific questions asked by the insurer, often relating to causation, impairment or appropriateness of care. Once completed, the insurer will obtain an unbiased report, based on objective data, to assist in making correct, timely claim decisions.
- Peer to Peer Consultation
In addition to a medical records review, the insurer may request a peer to peer consultation between PsyBar’s independent expert(s) and the claimant’s treating provider(s). The purpose of this consultation is to offer the independent expert and the claimant’s treating provider an opportunity to discuss and/or clarify any ambiguous information in the medical records and to potentially gather further information about the claimant’s condition, treatment and functionality.
- Co-Morbid File Review
A Co-Morbid File Review assesses a claimant’s medical records to accurately address claims that have both medical and behavioral health issues. A unique aspect of PsyBar’s co-morbid file reviews is a collateral call between our independent experts. The purpose of this telephone call is for each independent expert to gain additional information from the perspective of the other doctor’s specialty. The insurer will obtain an unbiased report from each specialist, based on objective data, to assist in making correct, timely claim decisions. Peer to Peer Review is also available for co-morbid files at the request of the insurer.
- Registered Nurse Review
PsyBar’s registered nurses provide high quality, medical & behavioral health file reviews. Each review delivers a comprehensive, evidence-based report addressing the claimant’s diagnosis, treatment and function. These reviews assist you when you are experiencing high volume, understaffed or your own nurses are on extended leave or vacation.
IME (Independent Medical Examination)
An IME is a one-time evaluation, generally performed by a doctor whose specialty matches that of the treating provider, and who is forensically trained to perform the examination and write a clear, concise, and unbiased report. These independent evaluations will provide the insurer a complete, comprehensive, and objective description of the claimant’s condition and its impact on functioning to aid the insurer in an accurate disposition of the claim. PsyBar offers independent evaluations in three specialty areas: psychological, psychiatric and neuropsychological. Our staff can work with you to help determine the proper professional areas of expertise.
- Independent Psychological Evaluations
These evaluations often involve individuals who may suffer from major mental illnesses and claim to be functionally impaired as a result. The independent evaluation typically includes an interview with the claimant, review of medical records, objective psychological testing, and a collateral call with the claimant’s treatment provider when appropriate.
- Independent Psychiatric Evaluations
These evaluations are quite similar to independent psychological evaluations but often psychotropic medications or their side effects and their impact on functionality are part of the claim’s disposition. PsyBar has a contracted expert psychologist who assures accurate interpretation of all testing to assist the psychiatric expert.
- Independent Neuropsychological Evaluations
These evaluations focus on claims where cognitive issues may play a role. Thus, an independent neuropsychologist can perform a comprehensive neuropsychological battery of tests as part of their evaluation.
Early Intervention Return to Work Program
We’ve all seen individuals who have taken a leave of absence from work due to depression, anxiety or trauma related incidents. While removing them from work might be necessary to allow for healing and return to function, when employees no longer have daily contact there may be a loss of social support, a sense of isolation and no reason to get up every day. Behavioral health leaves of absence can lead to inadequate treatment and misperceptions resulting in prolonged leave, often medically unnecessary and a costly loss of productivity.
PsyBar’s Early Intervention Return to Work program addresses these problems in a systematic, respectful approach coordinated and delivered by a PsyBar psychologist.
Education for Claims Professionals
The Commission for Case Manager Certification has approved PsyBar’s training program for those managing psychological/psychiatric claims. This program (approved for 3 continuing education credits) will help insurance professionals resolve claim issues quickly by effectively understanding the complexities of psychological and psychiatric Independent Medical Evaluations.