Property and Casualty Utilization Review Company Name* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Verify compliance with each of the following requirements set forth in MCA:* Your organization will use only licensed or certified health care professionals to conduct utilization reviews Utilization reviews must be conducted by health care professionals who are licensed or certified in the same specialty as the provider whose treatment is being received by the insured or by a health care professional who is qualified to render the treatment being reviewed Utilization review organizations shall comply with all applicable state or federal medical privacy laws Utilization review evaluations must use generally accepted standards for treatment of the illness, injury, or condition that is being reviewed Utilization review opinions must be signed by the health care professional performing the review A utilization review organization may not base its fees or charges on any recommendation for a reduction in payment under an insurance contract or on a percentage of claim savings Δ
