Article 5.5.1. Utilization Review Standards | MidpageArticle 5.5.1. Utilization Review Standards
State of California
9792.6Utilization Review Standards -- Definitions -- For Utilization Review Decisions Issued Prior to July 1, 2013 for Injuries Occurring Prior to January 1, 2013. [Repealed]9792.6.1Utilization Review Standards -- Definitions.9792.7Utilization Review Standards -- Applicability.9792.7.1DWC Form UR-01: “Utilization Review Plan Application or Modification.”9792.8Utilization Review Standards -- Medically-Based Criteria.9792.9Utilization Review Standards -- Timeframe, Procedures and Notice Content -- For Injuries Occurring Prior to January 1, 2013, Where the Request for Authorization is Received Prior to July 1, 2013. [Repealed]9792.9.1Utilization Review -- Receipt of Request for Authorization; Acceptance of Incomplete Request.9792.9.2Utilization Review -- Dispute of Liability; Deferral.9792.9.3Utilization Review -- Timeframes.9792.9.4Utilization Review -- Decisions to Approve a Request for Authorization.9792.9.5Utilization Review -- Decisions to Modify or Deny a Request for Authorization.9792.9.6Utilization Review -- Extension of Timeframe for Decision.9792.9.7Utilization Review -- Medical Treatment -- First 30 Days of the Date of Injury.9792.9.8Utilization Review -- MTUS Drug Formulary.9792.10Utilization Review Standards--Dispute Resolution -- For Utilization Review Decisions Communicated Prior to July 1, 2013 for Injuries Occurring Prior to January 1, 2013.9792.10.1Utilization Review -- Dispute Resolution.9792.10.2Application for Independent Medical Review, DWC Form IMR. [Repealed]9792.10.3Independent Medical Review -- Initial Review of Application.9792.10.4Independent Medical Review -- Assignment and Notification.9792.10.5Independent Medical Review -- Medical Records.9792.10.6Independent Medical Review -- Standards and Timeframes.9792.10.7Independent Medical Review -- Implementation of Determination and Appeal.9792.10.8Independent Medical Review -- Payment for Review.9792.10.9Independent Medical Review -- Publishing of Determinations.9792.11Investigation Procedures: Labor Code § 4610 Utilization Review Violations.9792.12Administrative Penalty Schedule for Utilization Review and Independent Medical Review Violations.9792.13Assessment of Administrative Penalties -- Penalty Adjustment Factors.9792.14Liability for Penalty Assessments.9792.15Administrative Penalties Pursuant to Labor Code §§ 4610, 4610.5, and 4610.6 -- Order to Show Cause, Notice of Hearing, Determination and Order, and Review Procedure.