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	<title>utilization review Archives - Claims Journal</title>
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	<title>utilization review Archives - Claims Journal</title>
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		<title>Pennsylvania Supreme: Non-Treating Providers May Not Intervene in Utilization Review</title>
		<link>https://www.claimsjournal.com/news/east/2021/12/23/307732.htm</link>
		
						<dc:creator><![CDATA[Jim Sams]]></dc:creator>
						<pubDate>Thu, 23 Dec 2021 06:00:17 +0000</pubDate>
				<category><![CDATA[East News]]></category>
		<category><![CDATA[medical fee review]]></category>
		<category><![CDATA[medical providers]]></category>
		<category><![CDATA[Pennsylvania Commonwealth Court]]></category>
		<category><![CDATA[Pennsylvania Supreme Court]]></category>
		<category><![CDATA[reasonable and necessary]]></category>
		<category><![CDATA[unconstitutional]]></category>
		<category><![CDATA[utilization review]]></category>
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							<description><![CDATA[In Pennsylvania, if an insurer contends that a medical service, drug or device is unnecessary, it must resolve the dispute through a process called utilization review, where medical professionals decide if the request is reasonable. The Pennsylvania Supreme Court ruled &#8230;]]></description>
				
		
		<enclosure url="https://www.claimsjournal.com/app/uploads/2020/10/bigstock-opioids-580x387.jpg" length="47334" type="image/jpeg" />	</item>
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		<title>The Power of Streamlined IT Investment:  Simplifying Claims Technology Implementation</title>
		<link>https://www.claimsjournal.com/news/national/2019/07/15/291944.htm</link>
		
						<dc:creator><![CDATA[Admin]]></dc:creator>
						<pubDate>Mon, 15 Jul 2019 05:00:36 +0000</pubDate>
				<category><![CDATA[News]]></category>
		<category><![CDATA[bill review]]></category>
		<category><![CDATA[claims adjusters]]></category>
		<category><![CDATA[decision-making process]]></category>
		<category><![CDATA[integrated systems]]></category>
		<category><![CDATA[pharmacy benefit management]]></category>
		<category><![CDATA[software]]></category>
		<category><![CDATA[third party liability]]></category>
		<category><![CDATA[utilization review]]></category>
		<guid isPermaLink="false">https://www.claimsjournal.com/?p=291944</guid>

							<description><![CDATA[In the past decade or so, the world has undergone tremendous technological transformation. For example, in 2008, only 139 million smartphones were sold, compared to 1.56 billion in 2018, according to Statista. In that same year, Uber didn&#8217;t exist yet &#8230;]]></description>
				
		
			</item>
		<item>
		<title>7 Technology Features to Look For In a Medical Management Software Platform</title>
		<link>https://www.claimsjournal.com/news/national/2018/12/04/288099.htm</link>
		
						<dc:creator><![CDATA[Admin]]></dc:creator>
						<pubDate>Tue, 04 Dec 2018 09:44:18 +0000</pubDate>
				<category><![CDATA[News]]></category>
		<category><![CDATA[Claims and Costs]]></category>
		<category><![CDATA[medical management]]></category>
		<category><![CDATA[Mitchell Casualty Solutions]]></category>
		<category><![CDATA[utilization review]]></category>
		<category><![CDATA[workers' compensation]]></category>
		<guid isPermaLink="false">https://www.claimsjournal.com/?p=288099</guid>

							<description><![CDATA[As medical costs continue to rise, workers&#8217; compensation payors are looking for methods to identify expenses that can be controlled and ways to handle claims more efficiently. According to a Lockton white paper, medical expenses are now averaging well over &#8230;]]></description>
				
		
			</item>
		<item>
		<title>The Art of Creating a Physician Peer Review Panel, Part I</title>
		<link>https://www.claimsjournal.com/news/national/2018/10/01/287008.htm</link>
		
						<dc:creator><![CDATA[Admin]]></dc:creator>
						<pubDate>Mon, 01 Oct 2018 08:27:14 +0000</pubDate>
				<category><![CDATA[News]]></category>
		<category><![CDATA[Mitchell International]]></category>
		<category><![CDATA[physician peer review]]></category>
		<category><![CDATA[utilization review]]></category>
		<category><![CDATA[workers' compensation]]></category>
		<guid isPermaLink="false">https://www.claimsjournal.com/?p=287008</guid>

							<description><![CDATA[Creating a physician peer review panel is like solving a puzzle – it comes together only after reviewing the landscape, discerning what is important, and identifying what resources are available. As in most industries, a problem or opportunity in the &#8230;]]></description>
				
		
			</item>
		<item>
		<title>California High Court Decision Limits Workers Right to Sue</title>
		<link>https://www.claimsjournal.com/news/west/2018/08/25/286435.htm</link>
		
						<pubDate>Sat, 25 Aug 2018 08:34:56 +0000</pubDate>
				<category><![CDATA[West News]]></category>
		<category><![CDATA[California Supreme Court]]></category>
		<category><![CDATA[utilization review]]></category>
		<category><![CDATA[workers' compensation]]></category>
		<guid isPermaLink="false">https://www.claimsjournal.com/?p=286435</guid>

							<description><![CDATA[The California Supreme Court on Thursday sided with employers in a fight over the right of workers to sue over treatment for injuries that occur on the job. Workers receiving medical care through the workers&#8217; compensation insurance of their employer &#8230;]]></description>
				
		
			</item>
		<item>
		<title>Cost Control and the Role of Precertification and Utilization Review in Workers&#8217; Comp</title>
		<link>https://www.claimsjournal.com/news/national/2018/06/25/285411.htm</link>
		
						<dc:creator><![CDATA[Admin]]></dc:creator>
						<pubDate>Mon, 25 Jun 2018 17:02:16 +0000</pubDate>
				<category><![CDATA[News]]></category>
		<category><![CDATA[Claims and Costs]]></category>
		<category><![CDATA[Mitchell]]></category>
		<category><![CDATA[precertification]]></category>
		<category><![CDATA[utilization review]]></category>
		<category><![CDATA[workers' compensation]]></category>
		<guid isPermaLink="false">https://www.claimsjournal.com/?p=285411</guid>

							<description><![CDATA[Medical expenses, now averaging well over 60 percent of average claims costs, according to a 2014 Lockton whitepaper, represent a significant impact on an employer&#8217;s workers&#8217; compensation total cost of risk. This trend isn&#8217;t going away soon, as this average &#8230;]]></description>
				
		
			</item>
		<item>
		<title>California Workers&#8217; Comp IMR Volume Fell Slightly in 2017, Outcomes Held Steady</title>
		<link>https://www.claimsjournal.com/news/west/2018/03/15/283624.htm</link>
		
						<pubDate>Thu, 15 Mar 2018 14:52:18 +0000</pubDate>
				<category><![CDATA[West News]]></category>
		<category><![CDATA[CWCI]]></category>
		<category><![CDATA[independent medical review]]></category>
		<category><![CDATA[utilization review]]></category>
		<category><![CDATA[workers' compensation]]></category>
		<guid isPermaLink="false">https://www.claimsjournal.com/?p=283624</guid>

							<description><![CDATA[New data on the Independent Medical Review (IMR) process used to resolve California workers&#8217; comp medical disputes show that IMR volume dipped for the first time ever in 2017, but the outcomes were unchanged as IMR physicians again upheld 91.2 &#8230;]]></description>
				
		
			</item>
		<item>
		<title>Oft Criticized Utilization Review in Workers&#8217; Comp Not Just About Savings</title>
		<link>https://www.claimsjournal.com/news/national/2016/04/27/270421.htm</link>
		
						<pubDate>Wed, 27 Apr 2016 16:19:07 +0000</pubDate>
				<category><![CDATA[News]]></category>
		<category><![CDATA[evidence based care]]></category>
		<category><![CDATA[GENEX]]></category>
		<category><![CDATA[utilization review]]></category>
		<category><![CDATA[workers' compensation]]></category>
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							<description><![CDATA[While critics say utilization review (UR) in workers&#8217; compensation claims is nothing more than a cost savings mechanism, an industry expert outlined its benefits recently. During a multimedia series, Inside Workers&#8217; Comp, Todd Andrew of Genex, a medical managed care &#8230;]]></description>
				
		
			</item>
		<item>
		<title>Early Lower Back MRIs May Lead to Longer, Costly and Unneeded Treatment</title>
		<link>https://www.claimsjournal.com/news/national/2014/08/20/253621.htm</link>
		
						<pubDate>Wed, 20 Aug 2014 15:06:21 +0000</pubDate>
				<category><![CDATA[News]]></category>
		<category><![CDATA[Liberty Mutual Research Institute]]></category>
		<category><![CDATA[lower back MRI]]></category>
		<category><![CDATA[lower back pain]]></category>
		<category><![CDATA[utilization review]]></category>
		<category><![CDATA[workers' compensation claims]]></category>
		<guid isPermaLink="false">https://www.claimsjournal.com/?p=253621</guid>

							<description><![CDATA[Inappropriate early use of Magnetic Resonance Imaging (MRI) to diagnose work-related lower back pain correlates with higher medical costs, unnecessary and ineffective procedures and prolonged disability, according to research conducted by the Liberty Mutual Research Institute for Safety. The most &#8230;]]></description>
				
		
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