Each managed care organization (MCO) must use nationally recognized treatment and return-to-work guidelines to evaluate the
necessity and/or effectiveness of medical care, and be able to use these guidelines to communicate and educate providers in
all decision correspondence. Most MCOs use Milliman and Robertson, Healthcare Management Guidelines™, Volume 7 and Mercy,
Guidelines for Chiropractic Quality Assurance and Practice Parameters.
Many national organizations use these guidelines in managing the care of injured workers, and they are consistent with other
guidelines that have been developed by expert panels. They place the provider and MCO on a level playing field to work
together to achieve the best outcome for the injured worker.
