Provider Resources

Inpatient/Outpatient Utilization Review Resources

• Washington State Department of Labor & Industries Provider Bulletins

Forms

• Checklist: Procedure Authorization Review Form
• List of Outpatient Procedures Requiring Utilization Review - current
• Surgical Review Request Form
• Group A Provider Outpatient Procedure Notification Form

Physical Medicine Resources

• Physical Medicine Review Request Form for Faxing Reviews
• Physical/Occupational Therapy Questionnaire in iEXCHANGE
• Physical/Occupational Therapy Questionnaire for Faxing Reviews
• Work Conditioning Questionnaire

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