The Pennsylvania Utilization Review Determination Face Sheet is a document used by health insurance providers in Pennsylvania to review and determine the medical necessity of health care services. It is used to determine if a health care service is medically necessary and should be covered by insurance. The Face Sheet includes information about the patient, the requesting provider, the requested service, and the determination of medical necessity. There are two types of Pennsylvania Utilization Review Determination Face Sheets: Medical Necessity Determination Face Sheet and Non-Medical Necessity Determination Face Sheet. The Medical Necessity Determination Face Sheet is used when the requested service is considered medically necessary. The Non-Medical Necessity Determination Face Sheet is used when the requested service is not considered medically necessary.
Pennsylvania Utilization Review Determination Face Sheet
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How to fill out Pennsylvania Utilization Review Determination Face Sheet?
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Form LIBC-344 First Report of Injury (FROI). As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within 10 days from notice of a work-related injury. Fatalities must be reported within 24 hours.
Under the Pennsylvania Workers' Compensation Act, injured workers are entitled to wage loss (?indemnity benefits?) based on the earnings at the time of injury. Generally speaking, indemnity benefits are calculated based on two-thirds (2/3) of your average weekly wage (?AWW?).
Workers' Compensation is tax-free. In Pennsylvania, the weekly compensation rate amounts to 66% of the injured worker's average weekly wage if they earned between $810.76 and $1,621.50 prior to the injury. For workers who earn between $600.56 and $810.75, the weekly compensation rate is $540.50.
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.
The maximum amount of wage loss benefits is based on the Department of Labor and Industry's calculation of the statewide average weekly wage. For the calendar year 2023 the maximum weekly compensation rate is $1,273.00. This amount only applies if you sustain a work-related injury in 2023 that results in wage loss.
The proposed employer assessment factor is 0.0318. This factor, in concert with the proposed employer assessment procedure, is subject to approval by the Insurance Commissioner.
The Employer's Assessment Fee Is 0.0289 (2.89%)
The Pennsylvania Workers' Compensation Act provides wage loss and medical benefits to compensate employees suffering from work- related injuries or diseases. The Act also provides for death benefits to the dependents of workers who die as a result of a work-related injury or disease.