N.C. Industrial Commission Utilization Review Rules

Effective January 1, 1996

All insurance companies and self-insured administrators providing benefits under the North Carolina Workers’ Compensation Act shall, within 90 days of the effective date of these Rules, adopt, file with the Chairman of the North Carolina Industrial Commission at 430 N. Salisbury Street, Raleigh, NC 27611 and implement a Utilization Review Plan for containing medical compensation services costs. If an entity has in effect a Utilization Review Plan that predates these Rules, it may file it with the Chairman of the Commission in lieu of adopting a new plan.

The goal of such plans shall be to reduce costs without adversely affecting the quality of care to injured workers.

Each plan shall provide for monitoring, evaluating, improving and promoting the quality of care and quality of services provided.

Each plan shall address all areas and aspects of health care included in medical compensation within the meaning of the Workers’ Compensation Act.

Provider profiles shall be maintained and shall be filed with the Chairman of the Commission on a biennial basis, or on such other basis as may be ordered by the Commission from time to time, with the first filing to be made no later than 90 days after the effective date of these Rules.

These Utilization Review Rules shall be effective on and after January 1, 1996.

N.C. Industrial Commission 4340 Mail Service Center Raleigh, NC 27699-4340
Main Telephone: (919) 807-2500 Fax: (919) 715-0282
NCIC Home Page: http://www.ic.nc.gov/