As part of the 1994 workers' compensation reform, KRS 342.035
required the commissioner of the Department of Workers' Claims to promulgate administrative regulations governing medical provider utilization review activities conducted by an insurance carrier, group self-insurer or self-insured employer. 803 KAR 25:190
, requiring every individual self-insured employer, group self-insurance fund and insurance carrier to implement a utilization review and medical bill audit program and submit a written plan describing the program to the commissioner for approval, became effective Sept. 19, 1995.
Amendments to the utilization review regulation were filed Aug. 15, 1996. The amendments were primarily housekeeping measures, clarification of the utilization review process and an attempt to ensure greater compliance. The amended regulation became effective Dec. 13, 1996.
In response to issues raised by medical providers and medical payment obligors, the regulation was revisited during the last quarter of 1997. Amendments to the regulation were promulgated and became effective June 15, 1998.
Legislative changes dealing with private review agent certification necessitated the most recent regulatory amendment effective March 19, 2001.