Retrospective UR vs AME (California) (California)

The filing and enforcement of liens (different states refer to these with different terms) to secure payment for services or goods against a workers' compensation award is complex and filled with special rules - this category is for questions and discussion of this special area of work comp law.

Retrospective UR vs AME (California) (California)

Postby comphealth on Fri Oct 15, 2010 12:00 pm

I have lien for treatment (medication both oral & topical) were the AME (12/15/08) expressed that the EE to be maintained with prescription medication, Although, UR has denied the treatment retrospectively. Majority of the dates are post AME report and all UR non-cert are as well.

Also when a physician a Neuro surgeon request/provided treatment to the PT, and it was not denied within the 5 day period, but rather sent to retro review months and denied. My understanding is no more than 30 days from the day received correct?

If a retro review is done within the 30 day period, is it required for notice to be sent for why it was delayed or anything type of notification , does 12/04 (re-enacted 4/05) CCR regs play a role here?

Thank you your help .
comphealth
 
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Re: Retrospective UR vs AME (California)

Postby ymcgavin@socal.rr.com on Sat Oct 16, 2010 12:44 pm

Hi Comphealth,

A few years ago I wrote an article for WCC titled, "Retrospective UR - When is it appropriate?" I believe that you can find the answers to your questions in that article. To review this article, click on the following link:
http://www.workcompcentral.com/signup/n ... 19fg8o19fv

York McGavin
ymcgavin@socal.rr.com
 
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Joined: Fri Apr 30, 2010 6:48 am


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