Read CASE MANAGEMENT and/or UTILIZATION REVIEW GUIDELINES text version

CASE MANAGEMENT and/or UTILIZATION REVIEW GUIDELINES There are required forms that must be submitted to the Workers' Compensation Division of the State of Tennessee for every lost time claim which requires case management and/or utilization review. A lost time claim is one in which the injured employee does not return to work within seven days after the accident or one in which there is a permanent disability ( regardless of days lost ). The notification forms are to be completed by the party who refers the case to the case management (c/m) and / or utilization review provider. The form should be submitted to the Workers' Compensation Division of the State of Tennessee immediately after the case has been referred. This is effective immediately. The closure forms are to be completed by the provider of either c/m or u/r. Please note that the utilization review closure has been revised; it has been separated into an inpatient and an outpatient form. It is the responsibility of the referring party to ensure that the u/r & c/m vendors are aware of the requirement to complete this form. These forms are to be submitted to the Workers' Compensation Division of the State immediately after case closure. This is effective immediately. Please contact the Workers' Compensation Division of the State if you need additional copies of these forms or if you wish to purchase a copy of the latest Tennessee Workers' Compensation Law which outlines the mandatory systems of c/m & u/r. You may direct questions regarding the completion of these forms to Suzy Douglas R.N. at (615) 5321326.

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CASE MANAGEMENT and/or UTILIZATION REVIEW GUIDELINES

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