Mandatory Utilization Review

(1) If the employer as defined in 0800-02-06-.01 disagrees with the authorized treating physician about the medical necessity of a recommended treatment, then the employer must participate in Utilization Review as defined in 0800-02-06-.01. (2) Utilization review is required to be performed pursuant to the requirements of this Chapter whenever it is mandated by T.C.A. § 50-6-124 or the Bureau’s Rules for Medical Payment, Medical Fee Schedule, or In-Patient Hospital Fee Schedule rules contained in Chapters 0800-02-17, 0800-02-18, and 0800-02-19, respectively.