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Treatment plan requirements

Note: This page is about claims not enrolled in an MCO. MCOs follow different guidelines. If you have questions for the MCO, you can find their contact information on our MCO page.

Overview
Let's get right to the bottom line: In order to get paid, ancillary service providers must:

  • Prepare a treatment plan for the injured worker before beginning treatment. (See below for treatment plan requirements.)
  • Send the plan to the insurer within seven days of beginning treatment.
  • Be licensed.

Treatment plan requirements

A treatment plan must include:

  • The name of the rendering provider
  • Specific treatment modalities
  • Frequency and duration
  • An explanation of how the care is related to the compensable condition

Within seven days, the plan, and its modalities and frequency, must be sent to the insurer. If the plan is not sent to the insurer in seven days, the insurer is not required to pay for any services related to the treatment outlined in the treatment plan.

All attending physicians, including chiropractors, nurse practitioners, and naturopaths, must also follow the rules regarding treatment plans.

Read more about treatment plans in the state administrative rules.

From saif.com

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