TREATMENT APPEAL PROCESS
All MCO’s are required to have an Alternative Dispute Resolution (ADR) process. The Alternative Dispute Resolution process is the mechanism utilized to solve disputes involving medical issues that arise between the BWC, MCO, employer, injured worker and/or provider.
ADR affords due process regarding conflicts in medical treatment issues. Parties wishing to appeal a medical issue should contact the MCO directly.
Disputed issues may include authorization or denials of medical treatment and diagnostic testing, requests for consultation, feasibility of Voc Services/closure or rehabilitation files, authorization or denials of medical equipment, supplies and services, nursing services and necessity of treatment.
AultComp MCO maintains an ADR process that is in compliance with the BWC regulations and includes the following steps:
All MCO’s are required to have an Alternative Dispute Resolution (ADR) process. The Alternative Dispute Resolution process is the mechanism utilized to solve disputes involving medical issues that arise between the BWC, MCO, employer, injured worker and/or provider.
ADR affords due process regarding conflicts in medical treatment issues. Parties wishing to appeal a medical issue should contact the MCO directly.
Disputed issues may include authorization or denials of medical treatment and diagnostic testing, requests for consultation, feasibility of Voc Services/closure or rehabilitation files, authorization or denials of medical equipment, supplies and services, nursing services and necessity of treatment.
AultComp MCO maintains an ADR process that is in compliance with the BWC regulations and includes the following steps:
- MCO issues a written decision on a treatment request from the physician of record or treating provider. Parties to the claim are notified and include the injured worker, injured workers representative (if applicable), employer and BWC.
- Day one of the ADR process occurs the day the MCO receives written notification of an appeal from any party to the claim.
- The MCO has 21 days to complete the ADR process. The process includes an independent peer review and/or an Independent Medical Examination (IME).
- MCO issues a BWC order based on the outcome of the peer review and/or IME. An appeal may be filed to the BWC order. The Industrial Commission hears all further appeals.
