New “Utilization Review” rules as of 1/1/18 to combat the rise in UR costs

We have seen UR fees run anywhere from $98 to upwards of $9,500 per treatment. 

  • Routine treatment such as PT, diagnostics and consults are usually approved with an average UR fee up to $500 per review.
  • The UR cost drivers are surgeries and opioids/narcotics - whether approved, modified or denied. 
  • We recently saw a TPA charge $9,500 in UR fees for a request for spine surgery because of the unbundling of the Utilization Review and fees.
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What is First Aid and how can it be managed?

Effective Jan. 1, 2017, all insured employers within the state of California must report all claims to their carrier or Third Party Administrator for which medical treatment costs are incurred. This includes reporting of first aid claims. If you have previously paid your “first aid” claims directly to the medical clinic, these costs must now be reported to the carrier and will impact your future Experience Modifier. 

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Organizing and Effective Safety Committee

An active and effective safety committee whose membership and functions are reflective of the company’s size, complexity, and operating exposures will play a key role in the overall performance of that company.  The Safety Committee is established to be of benefit first and foremost to the employees it represents, but it is also established as a safeguard and protector of the Company’s assets. 

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