What makes an MG-2 form complete?
All Board forms should be completely filled out with all available information. Certain information is essential to the Board’s internal procedures. Without that essential information, the Board cannot process the form. In order for the Board to take action on an MG-2 form, the Board requires that the following fields be completed. Section A: (1) Patient’s name, and (2) Insurance Carrier’s Name & Address. Please note that the Insurance Carrier’s or TPA’s name and address must match the information the Board has on file. Section B: (1) Individual Provider’s WCB Authorization Number for all providers authorized by the New York State Workers’ Compensation Board Section C: (1) Date Variance Request Submitted and Method of Transmission, (2) Guideline Reference for the body part followed by the 2 to 4 character corresponding reference in the Medical Treatment Guidelines or followed by the four letters N-O-N-E if there is no listed procedure, (3) Approval Requested For requires a written desc
Related Questions
- Designated Premises Supervisor Q: When an applicant for a premises licence also wishes to be the Designated Premises Supervisor, do they need to complete the form of consent in Schedule 2 of the application?
- Can a physical or occupational therapist complete the MG-2 form, send it to the treating physician for signature, and then submit the request to the appropriate parties?
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