Utilization Review Must be Limited to One Provider

In a workers’ compensation case, an injured worker saw two different medical providers who were in the same medical practice. The Commonwealth Court ruled that even so, a separate utilization review must be performed for each provider as to the reasonableness and necessity of care rendered to the patient. This means that an insurance company can no longer write on the utilization review request “and all other providers under the same license and specialty,” and expect to use one utilization review to cut  off care for all providers in the same practice or having the same specialty. (Bucks County Community College v. WCAB, Nemes, Jr., February 12, 2007.)


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