Clinical Modeling

Pharmacy Utilization Management

CorVel's clinical modeling program can help identify significant cost drivers in pharmacy utilization, prescription abuse and addiction, increased use of psychotic medications, and inappropriate prescribing. Our proprietary set of rules will flag certain indicators such as narcotics usage, length of use and certain drug combinations. CorVel has full visibility into a patient’s entire drug history that can include retail, mail order and physician dispensing.

Case identification. Not just big dollar claims.
Because of our integrated medical bill review system, CorVel captures all pharmacy transactions to provide an accurate analysis of all prescribed medications and drug therapies. We can proactively identify problematic cases before they become high dollar claims.

Attention to the details.
During medication review, our locally based clinicians review for medical necessity, injury work relatedness, step therapy protocols, duplicate medications, and medication contradictions. 

Comprehensive suite of services.
Our system reviews the entire patient history and triggers inappropriate use of narcotics and other medications, evaluates dispensing by multiple parties, and identifies interactions, contradictives or duplicates.