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Glossary of WCB Terms

 

 

Medical Treatment Guidelines
Carrier Contact Information

The regulations for Medical Treatment Guidelines require carriers to designate contacts to assist health care providers with Variance approvals, Optional Prior Approvals and Pre-Authorizations (C-4AUTH forms). Designated contacts must be updated within 10 business days of any change.

  • Variance approvals - Variances allow Treating Medical Providers to provide treatment that may not conform to the Guidelines. Variance must be requested and approved before treatment is provided..
  • Optional Prior Approvals - The Treating Medical Provider has the option of requesting prior approval from the insurance carrier to confirm that the proposed medical care is consistent with the Medical Treatment Guidelines. In addition to sending the optional prior approval request via fax or email, the provider may contact the carrier by telephone.
  • Pre-Authorizations - For the five body parts covered by the Medical Treatment Guidelines, pre-authorization is only required for the 10 procedures and second surgeries listed in the Medical Treatment Guidelines. The pre-authorization process, which is currently used for treatments or procedures exceeding a $1,000 threshold, will continue to be used for all other body parts.

Carriers must register for Medical Treatment Guidelines and at that time appoint an administrator who will be responsible for submitting contact information to the Board and for keeping the contact information updated. In addition, the administrator will be responsible for notifying the Board of Carrier Certifications, Opting Out of Optional Prior Approval and Waiving Right to Expedited Hearings. Please read Administrators Responsibilities.