Review of Medical Necessity (Utilization Review)
All health care rendered in the Texas workers' compensation system is subject to review by a Utilization Review Agent (URA) for the insurance carrier for reasonableness and medical necessity. This is called utilization review.
Utilization review can take place:
- Prospectively (before services are provided)
- Concurrently (extension of on-going health care)
- Retrospectively (after services are provided)
How to Become / Act as URA
In the Texas workers' compensation system, utilization review may be performed only by a certified URA. URAs are certified by the Texas Department of Insurance.
For definitions, rules, reporting requirements, and information related to becoming a certified utilization review agent, see the Utilization Review homepage.
For more information, contact:
Last updated: 09/06/2014