Official Disability Guidelines
MCOs use nationally recognized return-to-work guidelines to evaluate the necessity and/or effectiveness of medical care, and use these guidelines to communicate and educate providers in all decision correspondence. Many MCOs use Milliman and Robertson, Healthcare Management Guidelines™, Volume 7 and Mercy, Guidelines for Chiropractic Quality Assurance and Practice Parameters.
BWC elected to not renew its license with Milliman and Robertson beyond March 31, 2004, and will not refer to those guidelines in reviewing medical disputes during the ADR process.
BWC and MCOs use extensively the Official Disability Guidelines(ODG) — evidence-based treatment guidelines. The ODG do not replace the treatment guidelines MCOs use; but because ODG is a Web-based tool, BWC and MCO staff can easily search and find pertinent information necessary to everyday issues in claims and medical case management.
MCO staff began using these guidelines in making their treatment authorization decisions effective April 1, 2004. BWC staff uses the guidelines in the alternative dispute resolution (ADR) process.