The WCD has written new rules related to medial services that will go into effect April 1, 2019. While there are a number of changes, here are a couple of the most significant:
Requires MCO when less than 3 providers in a provider category in a geographical service area, to provide list of at least 3 physicians willing to treat claimant in given area. If the MCO does not provide the list or have anyone available, the worker is allowed to treat outside the MCO.
Allows worker to continue treating with current provider for 14 days (formerly 7 days) after being enrolled in the MCO before having to establish with MCO provider.
Removes statement that chart note is considered notice of request for surgery.
Creates new form (Form 5425 “Elective Surgery Notification”) for physician to complete to initiate request for surgery.
Renames Form 3228 “Elective Surgery Notification” to “Elective Surgery Response.”
Maintains all other current deadlines for the surgery review process.
Removes requirement for an indexed copy of claimant’s medical records for MRT disputes, you still must provide all relevant records in chronological order though,
If a contested case hearing is scheduled, you will get a copy of the packet back and then must submit exhibits for the hearing.
If you have any questions about these changes or how they might affect your claims, please contact me (; 503-595-2130).