Regulations
| 9792.5.8....Request for Independent Bill Review Form | |
| Request for Independent Bill Review. New section filed 12-31-2012 as an emergency; operative 1-1-2013 pursuant to Government Code section 11346. 1(d) (Register 2013, No. ...more | |
| 9792.5.9....Initial Review and Assignment of Request for Independent Bill Review to IBRO | |
| (a) Upon receipt of the Request for Independent Bill Review under section 9792. 5. 7, the Administrative Director, or his or her designee, shall conduct a preliminary ...more | |
| 9792.6....Utilization Review Standards-Definitions - For Utilization Review Decisions Issued Prior to July 1, 2013 for Injuries Occurring Prior to January 1, 2013 | |
| Â (a) âACOEM Practice Guidelinesâ means the American College of Occupational and Environmental Medicine's Occupational Medicine Practice Guidelines, Second ...more | |
| 9792.6.1....Utilization Review Standards-Definitions - On or After January 1, 2013 | |
| âClaims Administratorâ includes any utilization review organization under contract to provide or conduct the claims administrator's utilization review ...more | |
| 9792.7....Utilization Review Standards - Applicability | |
| The treatment protocols or standards governing the utilization review process shall be consistent with the Medical Treatment Utilization Schedule adopted by the ...more | |
| 9792.8....Utilization Review Standards -Medically-Based Criteria | |
| (a)(1) The criteria shall be consistent with the schedule for medical treatment utilization adopted pursuant to Labor Code section 5307. 27. Prior to adoption of the ...more | |
| 9792.9....Utilization 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 | |
| Â (a) The request for authorization for a course of treatment as defined in section 9792. 6(e) must be in written form. The requesting physician must indicate the need ...more | |
| 9792.9.1....Utilization Review Standards-Timeframe, Procedures and Notice - On or After January 1, 2013 | |
| The requesting physician must indicate if there is the need for an expedited review on the DWC Form RFA. The written decision shall contain the following information ...more | |
| 9793....Definitions | |
| Â (b) âContested claimâ means any of the following: Â (1) Where the claims administrator has rejected liability for a claimed benefit. Â (2) Where the ...more | |
| 9794....Reimbursement of Medical-Legal Expenses | |
| Â (b) All medical-legal expenses shall be paid within 60 days after receipt by the employer of the reports and documents required by the administrative director unless ...more | |