Experiencing a delay in workers' compensation utilization review decisions? File a complaint September 25, 2017 General Division of Workers' Compensation, Utilization Review, Workers' Compensation 0 The California Division of Workers’ Compensation (DWC) has finalized regulations to ensure that utilization reviews (UR) are conducted in compliance and within specified timeframes (see chart below). The regulations authorize DWC to conduct periodic reviews of all utilization review organizations (URO), including a review of any credible complaints against the organization received by the DWC Administrative Director. The California Medical Association (CMA) encourages physicians experiencing delays in the receipt of workers’ compensation UR decisions to be diligent in submitting complaints to DWC to highlight organizations that fail to meet the timely review standards. Physicians who find that UR is not being done according to the regulations can complete the UR complaint form and email it with a description of the issue to DWCManagedCare@dir.ca.gov. Indicate “UR Complaint" in the subject line. More information on filing workers’ compensation complaints can be found on the DWC website. For more information, see CMA On-Call document #7310, "Utilization Review," which provides an overview of California statutes and regulations regarding UR applicable to workers’ compensation insurers and self-insured employers. CMA On-Call documents are available free to members in CMA’s online health law library at www.cmanet.org/cma-on-call. Nonmembers can purchase documents for $2 per page. Practices that are experiencing UR delays should also contact CMA’s Reimbursement Helpline at (888) 401-5911 or economicservices@cmanet.org. Comments are closed.
