Bayview Consultants, Inc.

Bayview Consultants case management programs are effective tools for managing the coordination of medical care and meeting full recovery and return-to-work objectives.

Our nurse case managers work closely with a full team, including but not limited to the patient, the employer, insurer and treating providers, to ensure that the best medical options are utilized.

Both telephonic and field case management services are available for the following types of claims:

• Workers' Compensation
• Group Health
• Auto / PIP
• STD / LTD
• Vocational 
• Catastrophic /Multiple Trauma / Burns

Bayview Consultants, Inc. is a Certified Act VI  Peer Review Organization (PRO) within the Commonwealth of Pennsylvania. Our peer review product meets strict quality and time restriction standards.

Our Act IV Peer Review (PRO) Services include:  

• The collection of all appropriate medical documentation for review.
• A thorough, objective analysis of medical records by a board certified specialist
• License and specialty to determine the appropriateness of treatment.
• Determination of medical necessity, goal-oriented treatment, causality issues, and appropriate documentation of patient response to treatment program.
• Rationale for opinions based on accepted standards of medical practice.
• A complete report with clear recommendations for denial or future management of treatment.
• Report review by a Nurse to assure quality and clarity.
• Time frame: Maximum 90 days; Average 45 days.

Utilization Review services scrutinize the treatments, equipment, expenditures, and/or other issues related to an individual's care to determine if they are reasonable and appropriate for the diagnosis.

Bayview Consultants services include:

Independent Medical Evaluations (IME):

AnIME provides a clinical examination and review of the patient's available medical records by a clinician to determine a patient’s current medical status, relationship of claimant’s diagnosis to injury, need for continued treatment, and extent of disability.

Second Opinion:

A second opinion is the process of seeking an evaluation by another doctor or surgeon to confirm the diagnosis and treatment plan of a primary physician, or to offer an alternative diagnosis and/or treatment approach.

Medical Record / Peer Reviews:

When a face-to-face clinical evaluation is not required or possible, Bayview Consultants will acquire all pertain medical records prior to sending a comprehensive package to a qualified board certified physician of like license and specialty. We then request from our reviewer that all medical documentation made available will be reviewed and a comprehensive report outlining their concise recommendations for denial or future management of treatment will be subsequently submitted.

Radiology / Diagnostic Reviews:

Bayview Consultants utilizes Board Certified Radiologists to review studies such as X-rays, CT Scans, and MRIs. The reviewing physician may confirm or refute original study findings.  A final report with clear and concise recommendations by the reviewer for denial or appropriateness will be provided.

Bayview Consultants uses up-to-date technology and highly-trained medical analysts to review workers’ compensation and auto liability medical bills. All provider bills are reviewed and reduced to state fee schedule / usual, reasonable and customary fees or preferred provider adjustments.

If preferred provider discounts do not apply, then the bill will be referred for out of network negotiations for a desired rate within applicable timeframes.

Bill Review Services include:

• Coding review and re/unbundling
• Reasonable and customary review
• Fee schedule analysis
• Out-of-network bill review
• PPO management
• Repricing

Resulting Benefits:

• Multiple quality control checks
• Identification of over-utilization and unnecessary care
• Timely turnaround of bills
• Historical database for provider treatment patterns
• Data integrity
• Reduced medical costs
• Customized reporting