Ama Policy

Secondary Utilization Review H-320.960

U.R. Criteria

The AMA: (1) urges the Blue Cross and Blue Shield Association, the Health Insurance Association of America, and the American Managed Care and Review Association to develop mechanisms to coordinate utilization review procedures that are implemented by primary and secondary health insurance companies for a single case; (2) work with CMS to clarify on a national level that for patients who have Medicare indemnity as primary coverage, that the coverage and utilization management requirements of secondary payers are not applicable.

Policy Timeline

Sub. Res. 708, I-92 Appended by Res. 121, A-9 Reaffirmed: CMS Rep. 4, A-08 Reaffirmed: CMS Rep. 01, A-18