Mandatory Utilization Review, Independent Medical Review, and the Appeal Process

Every employer must establish a utilization review process. The utilization review process is the process by which the employer or other contracted entity reviews and approves, modifies, delays or denies physician requests for authorization before, during or after providing medical treatment services. Utilization reviews can occur before, during or after medical treatment to determine if the treatment is warranted.1 The physician’s treatment request can be modified, delayed or denied based upon the review, and the utilization review decision is valid for 12 months.2

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