Utilization Review

Topics	Durable Medical Equipment (DME)	Forms & Publications	Electro Medical Device Certification Request (M5)
Utilization Review	Treatment Guidelines	Utilization Review Guide	Provider Request for Adjustment (M6)
Physical and Occupational Therapy Window		Utilization Review Request (UR-C)

Guidelines
WSI uses reference materials to review for the “best practice”. Administrative Rule 92-01-02-33 (4) provides the outline for the reference material the organization may utilize:

Official Disability Guidelines (ODG)
American College of Occupational and Environmental Medicine’s Practice Guidelines
Guide to Physical Therapy Practice
Medical Disability Advisor
Diagnosis and Treatment of Physicians and Therapist Upper Extremity Rehabilitation
Treatment Guidelines of the American Society of Hand Therapists
Other treatment and disability guidelines or standards it deems appropriate to administer claims.