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Utilization Review

The Pennsylvania Workers’ Compensation Act provides for the process of medical treatment review under Section 306(f.1)(6) of the Act. The utilization review process provides for the impartial review of the reasonableness or necessity of medical treatment rendered to, or proposed for, work-related injuries and illnesses.

Utilization review of medical treatment is conducted by Utilization Review Organizations (UROs) authorized by the Secretary to perform utilization reviews for Pennsylvania workers’ compensation.

A utilization review may be requested by or on behalf of the employer, insurer or employee. Requests for utilization review should be filed online in the Workers’ Compensation Automation and Integration System (WCAIS). Parties who disagree with the findings of the utilization review may file a petition for review to be heard and decided by a workers’ compensation judge.