State RegulationsCO specificDifficulty 1/5
Under Colorado utilization review rules, the review criteria applied by a carrier's utilization review program must be:
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Colorado utilization review regulations, including Reg. 4-2-17, require that the criteria a carrier applies be written and applied consistently to similar cases, so that coverage decisions are ascertainable and uniform rather than ad hoc. This is a core standard the Colorado Division of Insurance enforces for utilization review programs.
Why the other options are wrong
- A) Criteria may not be hidden from treating providers; they must be written and applied consistently.
- C) Criteria are not invented claim by claim; they are written standards applied across similar cases.
- D) High-cost claims do not escape the application of utilization review criteria.
Memory hook
Written criteria, applied the same way every time.