Utilization Review in Workers' Compensation: Review of Current Status and Recommendations for Future Improvement

: Utilization review (UR) is a process that assesses aspects of a treating provider's care plans and then provides recommendations to payors/insurance carriers, third party administrators, etc, concerning the appropriateness of the proposed care. UR has become an integral part of medical practi...

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Bibliographic Details
Published inJournal of occupational and environmental medicine Vol. 62; no. 6; p. e273
Main Authors Bean, Melissa, Erdil, Michael, Blink, Robert, McKinney, David, Seidner, Adam
Format Journal Article
LanguageEnglish
Published United States 01.06.2020
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Summary:: Utilization review (UR) is a process that assesses aspects of a treating provider's care plans and then provides recommendations to payors/insurance carriers, third party administrators, etc, concerning the appropriateness of the proposed care. UR has become an integral part of medical practice and has influenced medical care within the workers' compensation (WC) system and is mandated in several states and jurisdictions. This guidance statement from the American College of Occupational and Environmental Medicine (ACOEM) reviews structural elements of UR programs and proposes a possible template for operational standards. UR has a unique role in protecting patients and educating providers on evidence-based guidelines, new research, and best practices.
ISSN:1536-5948
DOI:10.1097/JOM.0000000000001893