Newsline No. 56-07
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July 31, 2007

Division of Workers' Compensation posts utilization review FAQs for claims administrators on its Web site

The Division of Workers' Compensation (DWC) has posted answers to frequently asked questions (FAQs) about utilization review on its Web site to help claims administrators and others better understand utilization review (UR) rules and processes.

"Our goal is to help everyone understand UR so that injured workers receive the correct treatment at the right time," said DWC acting Administrative Director Carrie Nevans. "We intend to continuously update the page as new questions come in or related case law is decided."

The FAQs are posted on the DWC's UR Web page at http://www.dir.ca.gov/dwc/UR_Main.htm and can also be accessed from the DWC “what's new” page at http://www.dir.ca.gov/dwc/whatsnew.htm.

These FAQs are directed to claims administrators but others may also benefit from reading them. The division has a fact sheet on UR specifically for injured workers posted on its fact sheets and guides page at http://www.dir.ca.gov/dwc/iwguides.html.

Last month the DWC issued an advisory to support the establishment of "UR best practices," which allow claims administrators to approve appropriate levels of care for injured workers at the lowest possible levels within the claims organization, without having to send those requests through a third party process.

UR penalty regulations became final June 7, 2007 and UR rules have been in place since September of 2005. Both sets of regulations can be found at http://www.dir.ca.gov/dwc/DWCrulemaking.html.

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