 |
|
 |
PRE TREATMENT AUTHORIZATION
45 Day Presumptive Approval — for a period not to exceed 45 days following the date of injury, Provider's have presumptive approval for providing the following services when treating soft tissue and musculoskeletal injuries for the allowed conditions in allowed claims:
- Ten (10) physical medicine visits including Osteopathic, Chiropractic, Physical therapy & Occupational therapy
- Diagnostic studies, including x-rays, CAT scans, MRI scans and EMG/NCV
- Injections up to three soft tissue or joint injections (does not include epidural injections)
- E/M services and consultation services
NOTE: The following criteria must be met prior to initiating any or all of the aforementioned services for the 45 day presumptive approval to be valid:
- The Provider shall file the First Report of Injury (FROI) with the MCO
- The Provider shall complete and file the C-9 Treatment Plan with the MCO
- The Provider shall notify the MCO within 24 hours of treatment if the injured worker will be off work for more than 2 calendar days
HEALTH MANAGEMENT SOLUTIONS PRIOR AUTHORIZATION TABLE
For Services Not Covered Under the 45 Day Presumptive Approval Above
Also, See BWC Policy Guidelines Rev Jan 2001 P 3-14
|
| Service |
Pre-Authorization
|
| Consults (Psych/Chronic Pain Pgm) |
Yes |
| Dental |
Yes, Unless emergency |
| Diagnostic Testing |
No, If requested by POR for Diagnostic purposes |
| Durable Medical Equipment |
Yes, if over $250 |
| Home/Auto/Van Modifications |
Required from BWC |
| Home Nursing Services |
Yes |
| Injections |
Yes |
| Inpatient Treatment/Surgery |
Yes, Unless emergency |
| Non-Emergency Ambulance |
Yes |
| Nursing Home |
Yes |
| Outpatient Treatment/Surgery |
Yes, Unless emergency |
| Physical Medicine |
Yes |
| Referrals |
No; Please forward results |
| Routine Office Visits |
No; Please forward results |
| Vision |
No, with exception of surgery |
| Vocational Rehabilitation |
MCO will coordinate |
|
.
|
|
|
