Wednesday, June 27, 2007


It is important to keep in mind that all requests for authorization and all approvals as well as denials, delays and modifications are part of the UR process described in LC 4610 and the UR regs. An employer must have a UR plan with an appropriately credentialed and empowered medical director. Empowered to assure all decisions made in the UR process conform to the UR plan standards which must conform to LC 4610 and the UR regulations. The employer can contract out the UR responsibility thru h/h insurer, through a TPA or directly to a URO. If the employer just gets WC insurance or a TPA which, as part of the contract with the employer provides UR services (whether directly or through a subcontractor URO), that can satisfy the LC 4610 and the regs. However, it's the employer's responsibility to make sure that the contract documents cover the employer's duties under LC 4610 and the UR regs. It's the employer's responsibilities that the process is working.
As long as the Medical Director of the UR plan devises a way to ensure that the employer's claims adjusters (whether in house for a self insured employer or external through a TPA or WC insurer) are applying the standards of the UR plan (the plan the employer relies on to satisfy h/h LC 4610 and 8 CCR 9792.6 et seq responsibilities), the claims adjusters can approve medical treatment authorization requests. In so doing, they will be held to the same standards (timeliness, contents of communications) we would hold the URO to in complying with LC 4610 and 8 CCR 9792.6 for approvals.


Anonymous said...

Hi !.
might , perhaps very interested to know how one can make real money .
There is no initial capital needed You may commense earning with as small sum of money as 20-100 dollars.

AimTrust is what you need
The company incorporates an offshore structure with advanced asset management technologies in production and delivery of pipes for oil and gas.

It is based in Panama with structures around the world.
Do you want to become a happy investor?
That`s your choice That`s what you desire!

I feel good, I started to take up real money with the help of this company,
and I invite you to do the same. If it gets down to select a proper companion who uses your savings in a right way - that`s the AimTrust!.
I take now up to 2G every day, and my first deposit was 1 grand only!
It`s easy to get involved , just click this link
and go! Let`s take our chance together to become rich

Willy Somantri said...

Nice Information
my blogs that provide information about the world of health, diet, the benefits of fruits, vegetables curing of illnesses and

various health tips
please visit my site : healthy life