The updates add a new topic covering requests for authorization. More detailed information about prior authorization was also added, as well as a new question addressing when a claims administrator may deny a request for authorization without first obtaining a physician review. Other changes include a discussion of the utilization review investigation process, handling requests for authorization from secondary physicians, and agreed medical evaluator/qualified medical evaluator reports and utilization review. Additionally, there is a new discussion of the California Supreme Court's 2008 Sandhagen decision, whichheld that utilization review is mandatory and is required in every case but not necessarily for every treatment request. To view the updated frequently asked questions, visit www.dir.ca.gov/dwc/UtilizationReview/UR_FAQ.htm.
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April 4, 2011
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