Official Disability Guidelines Diagnosis Related Authorization Proactive Authorization
Official Disability Guidelines Diagnosis Related Authorization
Proactive Authorization Process n n ODG Standardized Authorization Guidelines combined with presumptive authorization. Diagnosis related proactive authorization of services for specific conditions, without the submission of a C 9. Phase I - 5/1/04 Phase II- 9/1/04 Notification sent to the provider and parties to the claim. Access to appropriate services for allowed conditions during the early stages of claim.
Benefits From The Diagnosis Related Authorization Process n n Creating a environment with a proactive approach to medical management and the coordination of services related to the claim. Reduced delay in early treatment. Reduced frustration and paper processing for treating providers. More time available to “Case Manage” the Injured worker and RTW issues.
Benefits Continued…. n n Consistency in treatment provided to Injured Workers’. Ability to focus on key areas to improve claim process for all parties. Decrease in medical treatment appeals. Overall improved claim outcomes.
Quality data….
Provider Survey Comments n “I think this program sounds like it will become a time saving & effective tool in bettering or improving the current process”. n “Best part was that IW did not have to wait for the treatment. Also cut down on paper work”. n “These innovative methods must be supported & further explored. The severe paperwork burden on providers & MCO's must be reduced”. n “Would like to see this used with all MCO’s”
Provider Survey Comments continued. . . n “It saves a lot of time with not having to fill out C 9's”. n “The physicians thought highly of the ODG program”. n “Has increased data entry to mark those clients records as not needing C 9’s whereas the rest of our clients still do need C 9’s”. n “If I was able to pull up the ODG guidelines per patient on the web, that would be great”. n “We like the concept”.
Diagnosis Related Authorization Process…future initiatives n Employer Surveys n IW Surveys n Continued Quality review of the outcomes.
Questions/Comments
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