Alternative dispute resolution (ADR)

ADR is the process for resolving medical disputes 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, but does not include fee schedule grievances. Providers can initiate a medical dispute in a workers’ compensation claim. Providers should contact the MCO directly. They must initiate their dispute 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;
• Treatment/service necessity;
• Health-care provider issues.

Click here for more information about the ADR review process.