Utilization Review (Ur) Complaint Form - California

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of the document for the current year.

Utilization Review (Ur) Complaint Form - California

Utilization Review (Ur) Complaint Form is a legal document that was released by the California Department of Industrial Relations - Division of Workers' Compensation - a government authority operating within California.

FAQ

Q: What is a Utilization Review (UR) complaint?A: A Utilization Review (UR) complaint is a complaint filed by an individual who disagrees with the outcome of a utilization review process.

Q: What is a utilization review process?A: A utilization review process is a method used by insurance companies to determine the medical necessity and appropriateness of healthcare services.

Q: How do I file a Utilization Review (UR) complaint in California?A: You can file a Utilization Review (UR) complaint in California by completing and submitting the UR complaint form.

Q: Do I need to include any supporting documentation with my Utilization Review (UR) complaint form?A: Yes, it is recommended to include any relevant supporting documentation with your Utilization Review (UR) complaint form.

Q: What happens after I file a Utilization Review (UR) complaint in California?A: After you file a Utilization Review (UR) complaint in California, the complaint will be reviewed and investigated by the California Department of Managed Health Care.

Q: Will filing a Utilization Review (UR) complaint affect my healthcare coverage?A: Filing a Utilization Review (UR) complaint should not affect your healthcare coverage.

ADVERTISEMENT

Form Details:

  • Released on April 1, 2014;
  • The latest edition currently provided by the California Department of Industrial Relations - Division of Workers' Compensation;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the California Department of Industrial Relations - Division of Workers' Compensation.

Download Utilization Review (Ur) Complaint Form - California

4.3 of 5 (7 votes)
  • Utilization Review (Ur) Complaint Form - California

    1

  • Utilization Review (Ur) Complaint Form - California, Page 2

    2

  • Utilization Review (Ur) Complaint Form - California, Page 1
  • Utilization Review (Ur) Complaint Form - California, Page 2
Prev 1 2 Next
ADVERTISEMENT