Utilization Review (UR)
Legal basis: LC §4610
Definition
The prospective, concurrent, or retrospective review process used by claims administrators to determine whether requested medical treatment is medically necessary under the MTUS treatment guidelines. UR decisions must be made by licensed physicians and follow specific timeframes established by regulation.
Key Facts About UR in 2026
QME Physicians in CA
~2,500
Evaluation Fee Range
$2,500-$4,000
Report Deadline
30 days
Avg AI-Assisted Turnaround
14 days
Related Terms
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Browse UR Physicians →Frequently Asked Questions
What is a Utilization Review (UR)?
The prospective, concurrent, or retrospective review process used by claims administrators to determine whether requested medical treatment is medically necessary under the MTUS treatment guidelines. UR decisions must be made by licensed physicians and follow specific timeframes established by regulation.
What is the legal basis for UR in California workers' compensation?
Utilization Review is governed by LC §4610 under California workers' compensation law. This statute defines the requirements, procedures, and standards for utilization review in the workers' compensation system as of 2026.
How much does a UR evaluation cost in California?
Utilization Review evaluation fees vary depending on the complexity of the case and the physician's specialty. Under California's Official Medical Fee Schedule (OMFS), medical-legal evaluation rates are updated annually. For current 2026 rates, consult the DWC fee schedule or contact IMEPro for guidance.