UTILIZATION MANAGEMENT ADMINISTRATIVE RULES
480-5-5-.01 SCOPE
480-5-5-.02 DEFINITIONS
480-5-5-.03 TIMELY PAYMENT OF UNDISPUTED MEDICAL CLAIMS
480-5-5-.04 STATEMENT OF SERVICES
480-5-5-.05 ENTITY QUALIFIED TO PERFORM BILL SCREENING
480-5-5-.06 UTILIZATION REVIEW ENTITY QUALIFIED TO PERFORM UTILIZATION REVIEWS
480-5-5-.07 UTILIZATION REVIEW PROCESS
480-5-5-.08 PRE-CERTIFICATION REQUIRED
480-5-5-.09 PROCEDURE FOR PRE-CERTIFICATION
480-5-5-.10 CONTINUED STAY REVIEW PROCEDURES
480-5-5-.11 TECHNICAL CONSIDERATIONS FORE REVIEW (BILL SCREENING) OF CLAIMS
480-5-5-.12 PHYSICIAN OF RECORD
480-5-5-.13 EMERGENCY CARE
480-5-5-.14 SECOND OR OPPOSING SURGICAL OPINION
480-5-5-.15 BILL SCREENING
480-5-5-.16 CONFLICT OF INTEREST: HEALTH FACILITY OWNERSHIP BY A PROVIDER
480-5-5-.17 OPTOMETRIC SERVICES
480-5-5-.18 CHIROPRACTIC SERVICES
480-5-5-.19 PHYSICAL THERAPY/OCCUPATIONAL THERAPY/SPEECH THERAPY SERVICES
480-5-5-.20 HOSPITAL SERVICES
480-5-5-.21 PRESCRIBED MEDICATIONS
480-5-5-.22 APPROVED STANDARDIZED MEDICAL REIMBURSEMENT FORMS
480-5-5-.23 APPEALS PROCESS FOR UTILIZATION REVIEW BILL SCREENING, PEER CLINICAL REVIEW AND DENIAL OR REVOCATION OF UTILIZATION REVIEW CERTIFICATE
480-5-5-.24 DISCHARGE PLANNING PROCEDURES
480-5-5-.25 ON-SITE AUDIT
480-5-5-.26 AMBULATORY SURGERY CENTERS
480-5-5-.27 ADMISSION REVIEW PROCEDURES
480-5-5-.28 DENTAL SERVICES
480-5-5-.29 MEDICAL CASE MANAGEMENT
480-5-5-.30 HOME HEALTH CARE SERVICES
480-5-5-.31 PAIN MANAGEMENT PROGRAM
480-5-5-.32 DURABLE MEDICAL EQUIPMENT
480-5-5-.33 TIME LIMITS FOR CLAIMS PAYMENTS
480-5-5-.34 AMBULANCE SERVICES
480-5-5-.35 IMPAIRMENT RATING GUIDE
480-5-5-.36 TIME LIMITS FOR EMPLOYEE FILING INCURRED EXPENSE CLAIMS
480-5-5-.37 OUT OF STATE MEDICAL PROVIDERS