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 request treatment that is not consistent with the MTGs, including requests to extend treatment beyond the maximum duration or frequency recommended in the MTG, or requests for treatment that is not recommended or not addressed in the MTGs. A 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 a participating 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 -With limited exceptions, care that is provided consistent with MTG recommendations does not require pre-authorization. Pre-authorization is only required for the 11 procedures and second surgeries listed in the Medical Treatment Guidelines for the back, neck, shoulder, knee, carpal tunnel syndrome and non-acute pain. For injuries not covered under the MTGs, the current preauthorization (C-4AUTH) process continues to apply for treatments or procedures costing more than $1,000.
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.