STEVEPSCA@YAHOO.COM Junior Member
Posts:
Joined: Jul 2007
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Saturday February 07, 2009 12:31 PM
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I can't answer you specific questions, but there is a thread in the 'legal' forum, discussing some of your issues with regard to the Chrio rights and reimbursement. You are probably aware, due to your DOI's, that there is a cap on PT/OT and Chrio of 24 visits per claim/injury. Only the ER/IC can authorize additional visits...and there is no UR, or judicial review process to dispute this.
If the Chiro was acting in the capacity of a "PTP", there could be surrounding issues here... as an 'office call' is not necessarily a 'visit' for treatment purposes...
The thread is here...http://www.workcompforums.com/ca/pro/messageview.cfm?catid=5&threadid=5214
<< They are from 2004 and 2005. The records show denials on most of the claims becuase of miscommunication between UR, adjuster, and PCP. >>
This is really going back a ways... has the case in chief settled... were there liens filed ? Was the denial appealed through LC4062 process by the IW/AA...? or exp herarings...? If the provider just dropped the issue due to 'miscommunication'... it would appear you have your work cut out for you...
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