spreare
Member
Posts: 91
Joined: Mar 2006
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Wednesday December 31, 2008 12:23 PM
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I think it has been well established that when UR determinations are not timely, then they cannot be presented as substantial evidence. We agree on this, yes?
However, when UR determinations are timely, they are presentable as substantial evidence.. And we have seen that among claims professionals, even on this board, they are willing to challenge liens up to a higher level, defending on the basis of negative UR determinations..... For me, as someone with hundreds of un-paid, and thereofre liened treatment bills, a signigicant question is this: does the timely UR determination bare equal evidence against my reports and reccomendations for treatment? IE, when I go to argue why treatment was within ACOEM guidelines (that which was self-procured as timely denied by UR), are my reports, findings, reccomendations, etc, on an equal footing of those UR determinations non-certifying treatment?
Fortunately, few of my mailed out POS treatment recc's are timely responded to, but there are some that are timely that I am concerend about.
THANKS!!!!!!!
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