Insurance Services

Determination

Precise Analysis to Improve Quality

WCRS policy writers and medical reviewers trained in over 70 specialties work together to review existing evidence and synthesize policy updates based on enhanced epidemiological review and the evidence-based modified Delphi approach.

WCRS Determination Services

Services

  • Enhanced Epidemiological Review
  • Guideline, Regulatory, & Evidentiary Update
  • Clinical Determination Review from MD/PharmD Reviewers
  • Update to Medical Codes
  • Upcoming Clinical Trial & Evidence Review

Frequently Asked Questions

How does an Epidemiological Review and how is it used with coverage policies?

Epidemiologic information is used as a factual framework for decision making by health officials responsible for policy development, implementation and evaluation. Epidemiologists use descriptive epidemiology to assess the health of a population or community by identifying relevant sources of data and analyzing these data by person, place and time. Our epidemiologists use descriptive epidemiology to analyze policies as they affect your populations and, when available, analyze comparison groups to fully understand and evaluate coverage.

How often should medical codes be updated?

New, changed and deleted CPT, HCPCS, and ICD-10-CM/PCS codes are issued yearly. CPT and HCPCS codes are effective on January 1st of each year, while ICD-10-CM/PCS codes are effective on October 1st of each year. Medical codes should be updated yearly as you update your medical policy documents.

Why should we consider upcoming clinical trials when updating our policy documents?

Upcoming clinical trials are an excellent source of information of the direction of research and evidence around many medical therapeutics and diagnostics, whether it be upcoming pivotal trials or additional, exploratory research on existing techniques.  Reviewing these yearly helps you to understand the direction your coverage determinations may take in future.

Our Model Is Effective And Current For 2021