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Vanderbilt Corporate Health Utilization Review-URAC Accredited

Vanderbilt Corporate Health Utilization Review

Contact Information:

Vanderbilt Corporate Health

3319 West End Avenue

Suite 950

Nashville, TN 37203

Faith Parrish RN CCM

Utilization/CM Manager

615-936-7352; Fax 615-322-8966

faith.parrish@vanderbilt.edu 

The UR Form which is attached must be completed and faxed to 615-322-8966 along with the MD order, i.e. therapy, MRI, surgery, etc. (this applies only to Vanderbilt employees treating under workers' compensation)

The hours of operation for Corporate Health UR are as follows:

Monday through Thursday: 8:00 AM to 4:30 PM

Friday: 8:00 AM to 3:30 PM

UR Review Request Form

Vanderbilt Corporate Health Services UR Mission Statement

Vanderbilt Corporate Health Services Utilization Review Unit was started in August of 2008 at the request of Vanderbilts Department of Risk and Insurance Management to assist in the medical management of Vanderbilt employees who have experienced work related injuries. Our utilization review team is composed of registered nurses whose strong clinical backgrounds aid them in making certification decisions.

Our Mission is to assure that the Vanderbilt University Medical Center and the Vanderbilt University injured workers receive appropriate, safe and effective care through the use of nationally recognized review criteria, as well as, consultation with Board Certified medical peer reviewers for determination of the medical necessity of their treatment plan.

Upon receiving a request for certification of medical necessity from the injured workers treating provider it is our goal to handle the request in a timely manner to assure there is no lapse in care which might be delay the injured workers recovery.

Rights to appeal

You have a right to appeal through Tennessee Department of Labor and Workforce Development.

http://tn.gov/workforce

Patient's Rights and Responsibilities

The patient will be treated without regard to his/her race, religion, beliefs, age, disability, sex, sexual orientation, gender identity or expression.

The patient has a right to have his/her complaints handled fairly. The patients care will not be affected if he/she reports a complaint.

The patient has a right to have their medical information kept private.

The patient has a right to appeal any denials related to the requested services via the Tennessee Department of Labor and Work Force Development Division of Workers Compensation. Every denial of treatment will be accompanied by a form prescribed by the Division that informs the patient how to request an appeal with the Division.

The patient has a right to be informed of the specific and detailed reasons for a denial.

It is the patients responsibility to follow the treatment plan as prescribed by their treating physician.

UR Appeals Process

Appeals Process

Appeals of a determination not to certify requested services should be submitted within 30 business days of the receipt of the decision not to certify the requested services. The request for appeal along with all supporting documentation and medical records should be submitted to:

Vanderbilt Corporate Health Services

Utilization Review Unit

3319 West End Avenue, Ste 950

Nashville, TN 37203

Tel. # 615-936-5959

The Appeal request and information may be faxed to:

615-322-8966.

The appeals decision will be determined within 30 days of the date the appeal was filed and the receipt of all necessary information.

The attending physician may telephonically request an expedited review related to ongoing services when that physician believes that the determination warrants immediate appeal. These appeals will be completed expeditiously, within 48 hours of the date the appeal is filed and the receipt of all necessary information.

Appeals may also be requested through the TDLWD Workers Compensation Division utilizing their Appeals Form (Form C35A) which was attached to the letter notifying you of the determination not to certify the requested services.

Appeals of a determination not to certify requested services should be submitted within 30 business days of the receipt of the decision not to certify the requested services. The request for appeal along with all supporting documentation and medical records should be submitted to:

Vanderbilt Corporate Health Services

Utilization Review Unit

3319 West End Avenue, Ste 950

Nashville, TN 37203

Tel. # 615-936-5959

The Appeal request and information may be faxed to:

615-322-8966.

The appeals decision will be determined within 30 days of the date the appeal was filed and the receipt of all necessary information.

The attending physician may telephonically request an expedited review related to ongoing services when that physician believes that the determination warrants immediate appeal. These appeals will be completed expeditiously, within 48 hours of the date the appeal is filed and the receipt of all necessary information.

Appeals may also be requested through the TDLWD Workers Compensation Division utilizing their Appeals Form (Form C35A) which was attached to the letter notifying you of the determination not to certify the requested services.

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