Which statement correctly describes filing UR policies and procedures?

Which statement correctly describes filing UR policies and procedures?

• A. They must be filed with the Administrative Director
• B. They must be filed with the Medical Director
• C. They must be filed with the WCAB
• D. They are not filed

Answer: (A)

In California self-insurance plans, utilization review policies and procedures must be filed with the Administrative Director of the Division of Workers’ Compensation. This filing places the UR framework under state oversight, ensuring the process for evaluating medical necessity and appropriateness meets required standards, timelines, and appeal rights. The Medical Director and the WCAB play important roles in medical management and disputes, but they are not the entities that receive or approve the UR policies and procedures. The filing requirement with the Administrative Director helps maintain consistency and compliance across SIPs, and a self-insured employer would update and resubmit as the procedures evolve.

In California self-insurance plans, utilization review policies and procedures must be filed with the Administrative Director of the Division of Workers’ Compensation. This filing places the UR framework under state oversight, ensuring the process for evaluating medical necessity and appropriateness meets required standards, timelines, and appeal rights. The Medical Director and the WCAB play important roles in medical management and disputes, but they are not the entities that receive or approve the UR policies and procedures. The filing requirement with the Administrative Director helps maintain consistency and compliance across SIPs, and a self-insured employer would update and resubmit as the procedures evolve.