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I continue to be amazed
If you want an interesting read, I pulled the paragraph below from seminar materials I resently prepared.

"Even if the records are produced by the provider under review within the proscribed time frames the URO may still issue a determination that the treatment is neither reasonable nor necessary if the required verification form signed by the doctor is not also provided in a timely manner. In Sexton v. WCAB (Forest Park Health Center), 974 A.2d 546 (Pa.Cmwlth. 2009) the provider under review did produce his records in a timely manner to the URO, but he failed to provide the signed verification form. As a result, the URO returned the records to the provider, failed to assign the UR to a reviewer and issued a determination that the treatments were neither reasonable nor necessary. A Petition to Review UR Determination was filed and the WCJ concluded that under Section 127.459© of the Workers’ Compensation Medical Cost Containment Regulations (Regulations), 34 Pa.Code § 127.459, a verification form was required, but the Regulations did not direct a URO to return timely received records for lack of verification. On appeal to the WCAB, the WCAB concluded failure to timely issue the verification form with the medical records to the URO was a failure to comply with the utilization review provisions."

Messages In This Thread
I continue to be amazed - TripleP - 08-09-2010, 04:16 PM
RE: I continue to be amazed - Timothy Belt - 08-10-2010, 11:15 AM
RE: I continue to be amazed - TripleP - 08-10-2010, 03:32 PM

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