For the procedures within the Guidelines that require pre-authorization, how do medical providers request it?
The request for pre-authorization should be made by completing the revised C-4AUTH form and submitting it to the insurance carrier and the Workers’ Compensation Board. • When performing an arthroscopy, sometimes the doctor does not know whether or not a chrondoplasty or acromioplasty is needed until the arthroscopy is completed. The arthroscopy is pre-authorized under the Guidelines, however the chrondoplasty or acromioplasty are not. Should the physician request authorization for every arthroscopy in the event a chrondoplasty or acromioplasty is needed? If, in making a determination regarding surgery, the surgeon believes that a chondroplasty or acromioplasty or other procedure requiring pre-authorization may be necessary, the surgeon should obtain pre-authorization for those procedures. The indication or reasoning for the potential for these requests should be clearly stated. • When a surgeon obtains approval for a procedure not on the pre-approved list, and prescribes physical thera
Related Questions
- If durable medical equipment is not addressed in the Guidelines, is a variance request required in order for the item to be supplied to the injured worker?
- If the Medical Treatment Guidelines clearly indicate that a certain procedure is not recommended, is a request for a variance appropriate?
- Do the procedures recommended by the Medical Treatment Guidelines require pre-authorization if the cost exceeds the $1,000 threshold?
