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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
  (a) “ACOEM Practice Guidelines” 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
“Claims Administrator” 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
  (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
  (b) “Contested claim” means any of the following:   (1) Where the claims administrator has rejected liability for a claimed benefit.   (2) Where the ...more
 
 
9794....Reimbursement of Medical-Legal Expenses
  (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
 
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