Utilization Review Forms

(1) All utilization review organizations must file with the Bureau the Utilization Review Notification form (Form C-35) electronically within three (3) business days upon initiation of utilization review services on an employee’s workers’ compensation claim. Only one form should be filed for each date of a utilization review referral even if more than one treatment is reviewed on that same date. (2) All utilization review organizations must file with the Bureau the Utilization Review Closure form (Form C-36/C-37) electronically for each C-35 filed within three (3) business days following the conclusion of utilization review services on an employee’s workers’ compensation claim. GENERAL RULES OF THE WORKERS’ COMPENSATION PROGRAM CHAPTER 0800-02-06 UTILIZATION REVIEW (3) If requested by the Bureau, a utilization review organization shall be required to file an annual report with the Bureau detailing the utilization review organization’s activities.