What patient history and physical examination findings must medical providers submit with an optional prior approval, variance, or pre-authorization request?
The patient history and physical examination findings that medical providers must submit will depend on the type of injury and the treatment (or proposed treatment) plan. In general, medical providers should include ALL patient history and physical examination findings that are relevant to the specific injury, diagnosis and treatment plan. At a minimum, medical providers must provide sufficient patient history and physical examination findings to demonstrate compliance with the medical treatment guidelines. If the patient history and physical findings do not fully document and demonstrate compliance with the medical treatment guidelines, the claim may be denied. Examples: The Back Injury Medical Treatment Guidelines state that lumbar/transforaminal/epidural injections must be fluoroscopically guided except in cases where radiation exposure is contraindicated and ultrasound evaluation of needle placement may be used. If a medical provider uses ultrasound evaluation of needle placement i
