utilization review (UR) law affect the process?
Section 8.7 provides that if an employer chooses to conduct utilization review, it must use organizations that are registered with the Illinois Department of Insurance and who certify compliance with URAC standards for Workers’ Compensation Utilization Management (WCUM) or Health Utilization Management (HUM). Click here for a list of approved UR providers. At the Illinois Department of Insurance, Kelly Smith (217/558-2309) coordinates the processing of the UR applications. If you have a complaint regarding a UR company not following the URAC standards (including the standards on the timeliness of responding to requests), you can file a complaint with the Illinois Department of Insurance. When making determinations concerning the reasonableness and necessity of medical bills or treatment, the IWCC will consider UR findings along with all other evidence. If an employer follows URAC standards when refusing to pay for or authorize medical treatment, there shall be a rebuttable presumption
Section 8.7 provides that if an employer chooses to conduct utilization review, it must use organizations that are registered with the Illinois Department of Insurance and who certify compliance with URAC standards for Workers’ Compensation Utilization Management (WCUM) or Health Utilization Management (HUM). Click here for a list of approved UR providers. At the Illinois Department of Insurance, Kelly Smith (217/558-2309) coordinates the processing of the UR applications. If you have a complaint regarding a UR company not following the URAC standards (including the standards on the timeliness of responding to requests), you can file a complaint with the Illinois Department of Insurance. When making determinations concerning the reasonableness and necessity of medical bills or treatment, the IWCC will consider UR findings along with all other evidence. If an employer follows URAC standards when refusing to pay for or authorize medical treatment, there shall be a rebuttable presumption
