Medical Treatment Guidelines Administrator Responsibilities
Carriers are required to designate an administrator for Medical Treatment Guidelines on the Carrier Registration form. A user ID and password will be provided so the Administrator can log-in to perform administrator responsibilities on the Board's web site. The user ID and password will be sent separately. The user ID will be e-mailed and the password sent via the US Postal Service to the addresses provided on the registration.
The following list describes the Medical Treatment Guidelines administrator's responsibilities:
- Primary contact with the Workers' Compensation Board regarding Medical Treatment Guidelines Carrier Contact information. Designated contacts must be kept up to date.
- Designate Contact(s) for Variance Request – name and contact information including direct telephone number, fax number, and e-mail address. If the designated contact changes at any time for any reason, the Board shall be notified within 10 business days of the change.
- Designate Contact(s) for Optional Prior Approval – name and contact information including direct telephone number, fax number, and e-mail address.
- Designate Contact(s) for Pre-Authorization Requests – name and contact information including direct telephone number, fax number, and e-mail address, must be provided.
- Notify the Board of Carrier Certification
The administrator is responsible for notifying the Board that the carrier has incorporated the Medical Treatment Guidelines into its policies, procedures and practices so that its utilization review and management criteria are consistent with the Medical Treatment Guidelines. Insurance carriers shall certify to the Chair by May 1, 2013, that they have incorporated the 2013 versions of the Medical Treatment Guidelines.
To notify the Board of carrier certification, the administrator should log-in and select the button for Carrier Options and Certifications. On the next page, select the button for Certification..
- Notify the Board if the carrier is opting out of the Optional Prior Approval process A carrier that has participated in the Optional Prior Approval process may opt out by notifying the Board. The carrier's decision to opt out will take effect 60 days from notification. A carrier may also opt in to the process by providing notice 60 days prior to beginning participation.
- Note: Effective March 1, 2013, when a variance request is denied, carriers are allowed to select a dispute forum preference (hearing or medical arbitrator) in each dispute . Prior election of medical arbitration for all disputes is no longer applicable. If either the carrier or injured worker selects hearing, an expedited hearing will be scheduled. If neither selects hearing, the dispute will be referred to the medical arbitrator.