The Division of Workers’ Compensation’s All About Claims newsletter indicates that the Division of Workers’ Compensation is working on a new electronic reference guide for adjusters entitled “Medical Treatment Guidelines Reference Guide for Adjusters.” The four most important elements to be featured in the new guide include:
- procedures or services which require Prior Authorization and subject the adjuster to a tight seven-day turnaround to admit liability for payment or get a practitioner’s written opinion that forms the basis for the denial;
- a list of “Not Recommended” procedures – those for which there is strong evidence of no short or long term benefit or which may be contraindicated in certain cases;
- Indications (both diagnostic and therapeutic) of when an adjuster should ask the medical provider to review the efficacy of current treatment based on the Guidelines; and
- Time Parameters that are specific to treatment duration and will be impacted both by claimant compliance and availability of services.
Check the web log for an announcement of when the Guide will be available online.