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Formulary Rules, Interpreter Fee Schedule Coming Soon

02/24/2017
medical review decisions Parisotto said he hopes the new formulary will take a chunk out of the persistently high volume of challenges to utilization review decisions. Injured workers in 2016 submitted 172590 eligible applications for IMR up from the 165427 submitted in 2013 and 142658 in 2014

Category: News

Baker and Parisotto Seek Collaboration to Carry Out Reforms

01/30/2017
IMR contractor generally gets a decision out within 14 days of receiving the medical records for a claim. At the end of 2015 it was taking Maximus an average of 24 days. Maximus received 253000 applications in 2015 and about 250000 in 2016. Some 165000 of the applications submitted in 2015

Category: News

San Bernardino Approves $100,000 to Hire 'Claim Expediter'

12/08/2016
medical records he said. Wert said the most pervasive problem the county has been dealing with in reviewing and approving treatment requests has been not receiving medical documentation to support requested treatments. These problems are isolated to employees being treated by providers who do not

Category: News

DWC: Large Percentage of Docs Fail to Properly Document Treatment Requests

11/16/2016
the possibility of misuse. And six cases included evidence that the drugs were being misused the division said. The divisions rules require claims administrators to forward to Maximus the same medical records it received with a request for authorization. This has been a concern for some

Category: News

State Fund's Chief Rides Tide of Litigation

11/11/2016
disputed medical decisions through review by doctors instead of the courts. IMR use plays out very differently in each state. California has an exclusive contract with Maximus Federal Services which in turn contracts with physicians to perform independent medical review. Texas assigns cases to 37

Category: News

WCIRB: Lower Utilization Drives Down Medical Payments per Claim

08/02/2016
specialists. At the same time the bill created the independent medical review process to determine if a utilization review decision rejecting a treatment as medically inappropriate was correct. Since it was launched in 2013 about 90 of IMR decisions have concluded that the requested treatment was not

Category: News

State Fund Paid $350,000 for Late IMR Records

07/27/2016
records to Maximus Federal Services the DIRs independent medical review contractor within 10 days. The Labor Code authorizes a penalty of up to 5000 per day for actions that delay the IMR process. The DIR on July 15 released a report on SB 863 that included data showing the average wait for

Category: News

DWC Fining Claims Administrators for Tardy Medical Records in IMR

07/20/2016
records late. It's of the utmost importance that medical providers and workers receive IMR decisions in a timely manner said Diane Worley of the California Applicants' Attorneys Association. "On the other side of every decision you've got an injured worker who's not receiving medical treatment

Category: News

WCAB Panel Overturns IMR Decision With 'Plainly Erroneous Finding of Fact'

04/28/2016
convincing evidence that any of these reasons for setting aside the IMR decision existed in Gonzalez-Ornelas's case but a WCAB panel rescinded her decision. Deputy Richard Newman joined Commissioners Frank Brass and Marguerite Sweeney in that ruling April 6. The panel noted that the records and

Category: News

Mesa Pharmacy Liens Since 2015 Demand Almost $100 Million

04/22/2016
independent medical review decisions issued in 2015. IMR affirmed the utilization review decision that compounds were not medically necessary in 98 of decision letters issued last year according to CWCI. Mesas lien volume could also start to drop significantly as its parent company told investors

Category: News

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