Is this MG-2 request valid?

In many instances, medical providers submit MG-2 requests for authorization of treatment that exceeds the Medical Treatment Guidelines. If the medical provider cannot support their request to deviate from the Medical Treatment Guidelines, the request must be denied. The treating medical provider must prove that the additional treatment is appropriate and that it is medically necessary to vary from the Board's Guidelines. 

 

The carrier can respond to the request by notifying all parties that the claimant will be examined by an Independent Medical Examiner or that the claimant's medical records will be reviewed by a Records Reviewer. However, the contradictory medical opinion must be filed within 30 days of receiving the MG-2 request.  This strict deadline often results in the carrier incurring high costs for an expedited medical opinion.

 

Before determining whether an independent medical opinion is needed, it should first be determined whether the MG-2 request is valid. An invalid or improperly completed MG-2 request can be denied without obtaining supporting medical evidence from an independent medical examiner.  The request can be denied for procedural deficiencies.  An MG-2 request must include the following: 

 

1.   The patient’s name;

2.   The insurance carrier’s name/correct address;

3.   The individual provider’s WCB Authorization Number;  

4.   The date the variance request is submitted;

5.   The method of transmission;

6.  The guideline reference for the body part followed by the corresponding reference in the MTG or followed       by the four letters NONE if there is no listed procedure;

7.    A written description of the treatment requested;

8.    Statement of medical necessity and supporting medical report;

9.   The contact method for the carrier and;

10. The Provider’s signature or stamp.

 

If the MG-2 request does not include all of the above-mentioned requirements, the request should be denied for procedural defectiveness and the basis for the denial can be specified on the MG-2D.

 

If you have additional questions on whether an MG-2 request can be denied, please contact Usra Hussain at uhussain@bhlfirm.com.