By: Meghan Gomez
The Bare Minimum Under the MTG
The Louisiana Medical Treatment Schedule and Dispute Resolution Procedures contained in the Medical Treatment Guidelines (“The Guidelines”) require that all treating medical providers submit an LWC-WC-1010 (“1010”) for all requests for non-emergent medical treatment which exceed the $750.00 threshold. The Guidelines further provide that all 1010s must, at a minimum, be accompanied by the following:
(1) a history up to the level of the injured worker’s current condition.
(2) physical findings and clinical tests.
(3) documented functional improvements from prior treatment (if applicable).
(4) test/imaging results.
(5) a treatment plan including services being requested along with the frequency and duration.
All of the above information is necessary for the adjuster and/or Utilization Review physician to determine whether the requested treatment is in compliance with The Guidelines and thus is medically necessary.
So, what do you do if the requesting provider fails to provide the required information?
You have two options:
- Deny the request outright as not in accordance with the Medical Treatment Schedule and attach a summary outlining the missing information; or
- Complete Section 4 of the 1010 advising the requested treatment will be delayed because the minimum information has not been provided and submit an LWC-WC-1010A to the provider outlining the missing information.
The latter is relatively underutilized. However, using the 1010A does have its benefits. Not only does it foster a more collaborative work environment, but it also can serve to prevent the repeated submission of the same 1010 and/or an immediate appeal to the Medical Director for denied treatment.