Specifications include, but are not limited to:UTILIZATION REVIEW TheWorkers’Compensation Oversight Panel is mandated to develop a utilization review program. 19 Del.C. § 2322C (1). Specifically, such a utilization review program shall provide references for employers, insurance carriers, and health care providers for evaluation of health care and charges. In addition, the utilization review program shall provide services for the prompt resolution of issues related to treatment and/or compliance with the health care payment system or practice guidelines for those claims, which have been acknowledged to be compensable. The selected vendor(s) conducting a utilization review program shall be required to certify compliance with the Workers’ Compensation Utilization Management Standards or Health Utilization Management Standards of URAC sufficient to achieve URAC accreditation. SERVICES TO BE PROVIDED The following is a description of the required services for DDOL’s Workers’ Compensation Uti l i z a t i o n R e v i e w P r o g r a m ( “ U R ” ) : Pursuant to the requirements of 19 Del.C. § 2322C (1), administer Utilization Review for the Delaware Department of Labor as follows: Review treatment to determine whether or not the following health care treatment adheres to t h e D e l a w a r e W o r k e r s ’ C o m p e n s a t i o n H e a l t h C a r e P a y m e n t S y s t e m ( H C P S ) a n d / o r t h e D e l a w a r e W o r k e r s ’ C o m p e n s a t i o n H e a l t h C a r e P r a c t i c e G u i d e l i n e s ( P G s ) : o Medical Treatment; o Chiropractice; o Diagnostic tests; o Hospitalization; o Outpatient Procedures; o Physical Therapy and other physical treatment modalities; o Surgery
