Ama Policy

Utilization Review by Physicians H-320.973

U.R. Criteria

1. It is the policy of the AMA to urge its constituent medical associations to (a) seek the enactment of legislation requiring that utilization review for insurers shall be conducted by physicians licensed by the state in which they are doing the review; and (b) seek enactment of legislation that would require all agencies or groups doing utilization review to be registered with the appropriate health regulatory agency of the state in which they are doing review and to have an appropriately staffed office located in the state in which they are doing the review.

2. Our AMA will continue to work with state medical associations to monitor utilization management policy to ensure that hospital admissions are reviewed by appropriately qualified physicians and promote related AMA model legislation.

Policy Timeline

Sub. Res. 175, A-90 Reaffirmation A-97 Reaffirmation A-06 Appended: CMS Rep. 1, I-14 Reaffirmation: A-18