Utilization Review

Topics	Forms & Publications	Electro Medical Device Certification Request (M5)
General Information	Utilization Review Guide	Provider Request for Adjustment (M6)
Authorization Process	Utilization Review Request (UR-C)	Independent Exercise or Work Hardening/Conditioning Program Requests (C59a)
Physical and Occupational Therapy Treatment Window	Utilization Review Request (UR-C) Guidelines
Durable Medical Equipment (DME)
Treatment Guidelines

General Information

The Utilization Review (UR) Department is responsible for determining the medical necessity for services based upon an injured worker’s clinical condition. Our staff utilizes evidence-based clinical guidelines from national and state authorities to guide utilization management involving prior authorization, concurrent review and retrospective review. The Utilization Review Guide outlines treatment requiring approval and is updated semi-annually, with the information available on the website.

It is the responsibility of the medical provider who provides or prescribes medical treatment, equipment, or supplies to submit requests.
Final Liability and payment decisions are the responsibility of the claims adjuster managing the claim.
Services will be reimbursed per WSI fee schedule.