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Review of Medical Necessity (Utilization Review)

All health care rendered in the Texas workers' compensation system is subject to review by a Utilization Review Agent (URA) for the insurance carrier for reasonableness and medical necessity. This is called utilization review.

Utilization review can take place:

  • Prospectively (before services are provided)
  • Concurrently (extension of on-going health care)
  • Retrospectively (after services are provided)

How to Become / Act as URA

In the Texas workers' compensation system, utilization review may be performed only by a certified URA. URAs are certified by the Texas Department of Insurance.

For definitions, rules, reporting requirements, and information related to becoming a certified utilization review agent, see the Utilization Review homepage.

For more information, contact:

Last updated: 9/6/2014