Prior Authorization Program
Western Integrated Care has established a Prior Authorization Program with its contract with Benchmark Administrators. The Prior Authorization Program provides its MPN physicians the authority to perform routine medical procedures without Utilization Review and without delay. Our MPN physicians must provide treatment consistent with the Medical Treatment Utilization Review Schedule.
Benefits
- Immediate treatment for the injured worker without delays.
- No Request for Authorizations for the services or treatments provided to the injured worker should be submitted; allowing the treating physician to spend more time with our injured workers vs completing paperwork.
- Early return-to-work and keeping employees working.
- Reduces cost, delivers medical treatment quicker and ensures the injured worker is taken care of.
- Through expedited care the injured work has greater satisfaction with care received, faster recovery and early return-to-work.
Pre-Authorized Services
- Physical Therapy, Occupational Therapy, Chiropractic and Acupuncture Treatment
- Follow Up Visits and Specialty Referrals through the MPN
- Medications
- Diagnostic Testing: X-rays, MRI, CT, EMG/NCS
- Tetanus Shot if applicable and over 10 years from last injection
- Durable Medical Equipment to include crutches, braces, splints, walking boots, cold packs, Tens Unit
How is the Prior Authorization Program Monitored?
- Western Integrated Care has dedicated Manage Care Specialists to monitor our MPN physicians and clinics for compliance to the California Medical Treatment Utilization Schedule.
- Western Integrated Care’s Manage Care Specialists works hand in hand with the Claims Adjusters.
- Western Integrated Care’s Nurse Case Manager will monitor the clinical side and ensure compliance.
Savings
- Prior Authorization ensures no wait time and early return to work greatly decreasing lost time and indemnity benefits.
- Most services provided by Western Integrated Care Networks with pricing below fee schedule.
- Less litigation due to injured workers increase satisfaction with the medical care.