ADR facilitates the resolution of medical disputes that arise between the managed care organization (MCO), BWC, employer,
injured worker, their representatives and/or provider without litigation. ADR affords due process regarding conflicts in
medical treatment issues, but does not include fee schedule grievances. With the implementation of the Health Partnership
Program (HPP), this is the first time providers can initiate a medical dispute in a workers’ compensation claim. Providers
initiating a medical dispute should contact the MCO directly. Providers must initiate ADR within 14 days after they
receive the initial decision in writing from the MCO.
ADR can address the following issues:
Quality assurance;
Utilization review;
Determination that a service is or is not covered;
