Provider enrollment

Becoming an eligible provider with SAIF

Becoming an eligible provider with SAIF could be as simple as one phone call. If you are a licensed provider who is new to Oregon and who would like to treat injured workers covered by SAIF, please call 800.285.8525 and ask for Medical Audit Review.

Becoming an MCO provider

Managed care organizations are a vital part of the workers’ compensation system, working side by side with SAIF and injured workers to help the worker recover and return to work.

If you are interested in becoming an MCO provider eligible for payment through SAIF, or if you are a panel member, contact these MCOs about their application process.

If you are placed on an MCO panel, the MCO will send us your information and your name will be entered into our system.

MCO providers

• CareMark 503.413.5800
• Kaiser On-the-Job 503.721.3940
• Oregon Health Systems 800.525.0394
• Providence MCO 800.947.4707

Becoming an IME provider

To bill with SAIF or to work with us as an independent medical examiner, we require you to be authorized by the Oregon Workers' Compensation Division (WCD) to conduct independent medical exams (IMEs) on Oregon injured workers.

As part of our comprehensive care for injured workers, we accept IMEs from qualified medical providers who meet the workers' compensation system guidelines.

To become an IME provider, read the information on this page about the role that IME providers play. Then, send a cover letter and your professional vitae to us at:

Lisa Wilch
Claims Supervisor - Special Projects
400 High St SE
Salem, OR 97312
P: 503.315.3520 or 800.285.8525
F: 503.945.3520

Keep in mind that IME providers (and worker-requested medical exam providers) must be authorized by WCD. For more information on becoming authorized, contact WCD at 503.947.7583.

SAIF IME partners

SAIF partners with these companies to provide independent medical examination services:

• Health Cost Management (HCM)
• Medical Consultants Network (MCN)
• Oregon Medical Evaluations (OME)
• Orthopaedic Consultants PC (OC)
• STAR Medical
• Sunrise Medical Consultants (SMC)
• Abeton

When an IME is needed

A SAIF claims adjuster may request an independent medical examination if the adjuster is unable to obtain the necessary medical information from the attending physician, if there is disagreement over cause of the condition, or if the patient's recovery is atypical.

The purpose of IMEs

Independent medical examinations (IMEs) are performed by a physician or other health care provider who is not usually involved in the worker's care, to clarify medical and case issues at the request of the insurer.⁽¹⁾

IMEs may be performed to provide a diagnosis or a treatment plan or to provide an opinion on the cause of a worker's medical condition and may be used as evidence in legal proceedings in cases when a dispute exists.⁽²⁾ They are a component in the medical analysis and will be sent to the attending physician for review.

IMEs can be conducted at several stages during the cycle of injury/illness, treatment, rehabilitation, and return to work.⁽³⁾ These evaluations vary in complexity, depending upon the specifics of the case and the issues involved. Most evaluations are based on a single visit with the examining physician.

Other things you should know

It is important that an IME physician understand Oregon's workers' compensation rules and laws in effect at the time of the examination.

The claims adjuster will provide copies of the injured worker's medical information and diagnostic studies in addition to a letter to the IME provider outlining details of the case and questions to be addressed during the exam. The adjuster may also include a definition of the applicable legal standards based on the date of injury and type of claim.

Helpful links to information regarding the Oregon IME process:

• WCD overview of the IME process
• WCD brochure regarding the IME process
• WCD list of authorized IME evaluators

There's a lot to know about the role of an IME provider. As always, don't hesitate to contact us at 800.285.8525.

 

Footnotes:

1. Brigham CR, Engelberg AL. The disability/impairment evaluation. In: McCunney RJ, ed. A Practical Approach to Occupational and Environmental Medicine, 2nd ed., Boston, MA: Little, Brown; 1994: 85.
2. Brigham CR, Mangraviti JJ, Babitsky S. The Independent Medical Evaluation Report: A Step-by-Step Guide with Models Falmouth, MA: SEAK, Inc.; 1996.
3. Demeter SL, Andersson GBJ, Smith GM. Disability Evaluation. St. Louis, MO: Mosby; 1996.