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New York State
Workers' Compensation Board
OFFICE OF THE CHAIR
20 Park Street   Albany, New York 12207
Governor David A. Paterson


Subject No. 046-449

Critical Carrier Contact Information For Medical Treatment Guidelines

Date: November 1, 2010

ATTENTION: This Subject Number contains critical time-sensitive information. To guarantee that carrier contact information is available by December 1, 2010, carriers must designate and register an administrator by November 5, 2010.

Carrier Administrator

Carriers are required to designate an administrator for Medical Treatment Guidelines on the Carrier Registration form, available on the Board's website at: http://www.wcb.ny.gov/content/main/hcpp/MedicalTreatmentGuidelines/MTGCarrierContacts.jsp

After the registration is processed, the administrator will be provided a user ID and password to log in and perform administrator responsibilities. The user ID will be e-mailed and the password will be mailed via the US Postal Service to the administrator's addresses, as provided on the registration. Note: This process is similar to the online forms registration process. Due to the anticipated volume, this registration process could take up to two weeks.

Carrier Contact Information

Carriers are required to designate an employee(s) or an individual(s) to represent them as a point of contact for the Board and treating medical providers regarding optional prior approval requests, variance requests and pre-authorization requests.

Carriers must notify the Board electronically via the Board's website of their contact(s) by December 31, 2010 at: http://www.wcb.ny.gov/content/main/hcpp/MedicalTreatmentGuidelines/MTGCarrierContacts.jsp

Optional Prior Approval

The optional prior approval process allows a treating medical provider to request a determination from a participating carrier regarding whether the requested treatment is a correct application of the Guidelines. In accordance with the regulations, all carriers are automatically deemed participating in the Optional Prior Approval process unless they formally opt-out.

Participants in the pilot program for the Medical Treatment Guidelines stated that the optional prior approval process encouraged communication and was very successful in mitigating concerns in the early part of the process for both treating medical providers and carriers. It also resulted in fewer contested medical treatments. In the pilot, the Board also found that the number of optional prior approvals dropped as providers became more confident that they would be reimbursed for treatments rendered consistent with the Guidelines. Accordingly, the Board is strongly encouraging all carriers to participate in the Optional Prior Approval Process.

Any carrier choosing to opt-out of the Optional Prior Approval process effective December 1, 2010, must designate an administrator (see Carrier Administrator) no later than November 5, 2010, to set up an account. That administrator, once authorized, will be provided instructions on how to opt-out.

Thank you for your cooperation.

 

Robert E. Beloten
Chair