Certified UR agencies must contact the treating practitioner prior to making any adverse determinations. All adverse determinations must be made by a licensed practitioner with the same or similar specialty. The UR Program sets reporting requirements for UR agencies and allows for complaint investigation. During FY1999, OMCR received 961 complaints. If concerns extend beyond an individual complaint, OMCR investigates the organization's operation.
Investigations attempt to verify compliance with certification and regulatory requirements.
OCMR uses complaint management and investigations to assure that quality and continuity of health care is delivered to the public.