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What is Utilization Review and how does it work?
The utilization review process compares requests for medical services ("utilization") to treatment guidelines that are deemed appropriate for such services and includes the preparation of a recommendation based on that comparison.
Complete details regarding L&I's Utilization Review Program can be found in Provider Bulletin 06-06 (151 KB PDF). The Utilization Review Program applies only to claims that are adjudicated by the State Fund. The program applies to both physicians and facilities.
Avoid Utilization Review Delays
To reduce or avoid Utilization Review delays, follow these suggestions.
Physical & Occupational Therapy Utilization Reviews
Find out what the procedures are to request a utilization review and to obtain authorization for physical and occupational therapy services.
