Utilization Review

Effective July 1, 1993, all workers compensation insurers are required to undertake utilization review of injured workers health care services. The Utilization Review and Quality Assessment Program, 452 CMR 6.00 et seq applies to all claims irrespective of date of injury, for health care services rendered on or after October 1, 1993.

Arrow Mutual Liability Insurance Company is an approved Utilization Review Agent by the Commonwealth of Massachusetts, Department of Industrial Accidents, since 1994. Arrow UR is in good standing with the DIA and has had no violations imposed on them.
Arrow Mutual’s Utilization Review Department will perform Utilization Review of all medical treatment of workers’ compensation claims in accordance with MGL Ch 152, Section 13 and 30 of the Massachusetts Workers’ Compensation Act and the Massachusetts Utilization Review Regulations, 452 CMR 6.00 et seq. This process is being implemented to assure that the appropriate medical care and treatment is medically necessary and appropriate and is being maintained.

Arrow Mutual UR reviewers are MA licensed RN’s, with CPUR certification and are required to obtain CEU’s for their MA RN/CPUR designation on an ongoing basis.

Arrow Mutual’s Medical Director (Richard Zimon, MD) is MA licensed, with Board Certification in Occupational Medicine. He is also a member of the Health Care Services Board (HCSB) of the DIA/OHP. His duties include providing first level reviews, writing internal guidelines, the QA of the UR program, and providing in-service education to the UR staff.

 

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