More Reasons Claims Are Denied: Concordance Rates
What if the peer reviewer is out of sync with medical necessity criteria? How would you know? Looking at concordance rates organized by individual reviewers is one way to review the reviewers performance. Concordance Rates- This rate measures of a Peer Reviewers’ decision to authorize, partially authorize, or deny and compares this decision to the care manager’s belief that the case is not meeting Medical Necessity Criteria for that level of care.