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The original two-sided utilization review closure form should be submitted to the State of. Instant access to fillable Microsoft Word or PDF forms.Minimize the risk of using outdated forms and eliminate rejected fillings. IMO is approved in various states to provide Utilization Review services. As your utilization review (UR) vendor, we want to keep you informed of regulation updates that impact the UR business. Complete the UR Review Request (UR-C) form and fax it with supporting documentation to 866-356-6433 or 701-328-3765. Q. What is utilization review (UR) and why is it used for workers' compensation? The 2nd Utilization Review – Company License Application must be completed and attached to the NIPR warehouse. A retrospective review is generally performed after treatment is complete. The MCO DUR program must be as comprehensive as the states FFS program.