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. MCOs use The Official Disability Guidelines
(ODG).
The ODG are evidence-based treatment guidelines that BWC and the MCOs
use extensively. They are available to staff at BWC and MCOs on their desktops.
The ODG do not replace the treatment guidelines MCOs currently use; however, because
the ODG are in a Web-based tool, BWC and MCO staff can easily
search and find pertinent information necessary to everyday issues in claims and
medical case management.
MCOs began using these guidelines in making their treatment authorization
decisions effective April 1, 2004. However, BWC has advised them to use the Mercy,
Guidelines for Chiropractic Quality Assurance and Practice Parameters to support
opinions regarding authorization of chiropractic services in MCO ADR disputes.
