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Our blog where we keep you on top of the latest updates that are setting the Pennsylvania Workers' Compensation industry ablaze.


CMS released its new User Guide on July 3, 2012.


Within the user guide CMS outlines the recent changes with mandatory TPOC dollar thresholds for both liability and workers' compensation which were released on June 20, 2012. It also contains information on the ORM extension for mandatory minimum dollar threshold for workers' compensation which remains at $750 for medical only claims. For additional detail see the link below.


The other significant change with reporting was CMS lifting the restriction on additional file submissions for liability, no fault and workers' compensation. Reports can now be submitted outside of the required period but no more frequently than every 14 days.

The revised Utilization Review Form is now being accepted by the PA Bureau of Workers Compensation as of 10/24/2011. The new form will be required as of 1/2/2012.

What does the new form offer? It allows you to list up to 5 providers on one form. In practices where multiple providers of the same specialty can treat the same patient such as physical therapy or chiropractic treatment, this will allow one review of multiple providers, vs. having to file a Utilization Review for each provider. If one reviewer is assigned then there will be consistency in the review determination vs. before where mutliple reviewers were assigned to the mutliple providers. This should also help to reduce the cost of the Utilization Review where there is one specialty.

Also new to the form is a section to include the WCJ Circulation Date. If payment for the treatment was withheld because treatment was under review, the date of the decision will show the reason for the delay and define the time frame the request can be made.

You can find the new form at the PA Bureau website at http://www.portal.state.pa.us/portal/server.pt?open=514&objID=552595&mode=2

Just in! The latest edition of the NGHPR User Guide, Version 3.2 is now available on CMS' website. Here is the link to obtain your copy of the manual: http://www.cms.gov/MandatoryInsRep/Downloads/NGHPUserGuideV3.2.pdf

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