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Get the free FORM 9-E UTILIZATION REVIEW OR HEARING REQUEST FORM - orm dc

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GOVERNMENT OF THE DISTRICT OF COLUMBIA OFFICE OF RISK MANAGEMENT Jed Ross Chief Risk OfficerPublic Sector Workers Compensation Programmer 9E UTILIZATION REVIEW OR HEARING REQUEST FORM This form is
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How to fill out form 9-e utilization review

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How to fill out form 9-e utilization review

01
To fill out form 9-e utilization review, follow these steps:
02
Start by providing your personal information, including your name, address, and contact details.
03
Indicate the date of the review and the specific type of utilization review being performed.
04
Specify the patient information, such as their name, date of birth, and medical record number.
05
Include the details of the treating healthcare provider, including their name, contact information, and specialty.
06
Provide a detailed description of the medical services or treatment being reviewed.
07
Indicate whether the medical services were pre-authorized or if they are being requested for retrospective review.
08
Attach any relevant supporting documentation, such as medical records, test results, or treatment plans.
09
Sign and date the form to certify the accuracy of the information provided.
10
Submit the completed form to the appropriate entity responsible for conducting the utilization review.

Who needs form 9-e utilization review?

01
Form 9-e utilization review is typically needed by healthcare providers, insurance companies, and other entities involved in the review and authorization of medical services or treatments.
02
It is utilized to gather information about the specific medical services being reviewed, ensuring their compliance with medical necessity and appropriateness guidelines.
03
This form helps determine whether the requested or provided medical services should be approved, denied, or modified based on the review outcome.
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Form 9-e utilization review is a document used to evaluate the appropriateness and necessity of medical treatment provided to injured workers.
Medical providers and insurance companies are required to file form 9-e utilization review when requesting authorization for medical treatment for injured workers.
Form 9-e utilization review should be filled out with detailed information about the requested medical treatment, including the justification for its necessity.
The purpose of form 9-e utilization review is to ensure that medical treatment provided to injured workers is appropriate, necessary, and in compliance with the law.
Form 9-e utilization review must include information about the injured worker, the medical treatment requested, the medical provider, and the reasons for the requested treatment.
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