Successful Utilization Review Audit November 2016
As a third party claims administrator that operates in the State of California, Athens Administrators is subject to routine utilization review audits every three years. The purpose of the this audit is to make certain that all involved parties have complied with the requirements of California Labor Code section 4610(i) and California Code of Regulations, title 8, sections 9792.6 through 9792.12. The focus of this independent audit consists of a review of our utilization review plan and randomly selected sample of requests for authorizations. Once the audit has been completed, the State of California provides a percentage rating for the third party administrator in the following areas:
- The percentages of randomly selected requests where there was a failure to make and/or provide timely response to a request for authorization;
- The percentages of randomly selected requests where there were notices with faulty content;
- The percentages of randomly selected requests where there was failure to issue notices to all appropriate parties.
Athens Administrators recently went through an independent State audit, which concluded in late October 2016 and we are extremely proud of the results we were able to achieve. Our overall score for this audit was a 99.4%! This near perfect score demonstrates our on-going commitment to exceptional quality and appropriate care for our client’s injured workers.