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Medicare Set-Aside Arrangement Reference Guide November 6, 2013
      The following sections of the Guide have been enhanced or added:

  • 9.4.1.1 – Most Frequent Reasons for Development Requests: The five most common omissions as provided by the Workers’ Compensation Review Contractor (WCRC).
  • 9.4.2 – WCRC Team Background and Resources Used: The expertise of the WCRC reviewers as well as the resources used when reviewing a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA).
  • 9.4.3 – WCRC Review Considerations: Examples of the questions and factors that guide the WCRC’s review of WCMSA proposals. The overarching guidelines used in treatment allocations and pricing is also provided.
  • 9.4.4 – Medical Review: A diagram and steps the WCRC follows in its medical review process with a general explanation of documentation requirements.
  • 9.4.5 – Medical Review Guidelines: Considerations and examples in specific medical cases and topics.
  • 9.4.6.1 – Prescription Drug Review: Details the process the WCRC follows in reviewing prescription medication allocations and the resources that may be used.
  • 9.4.6.2 – Pharmacy Guidelines and Conditions: Discusses specific drug usage and pricing considerations.
  • 10.1.8 – Pay history added to list of information needed for WCMSA submission.

NCCI Experience Rating Information
NCCI Residual Market (Assigned Risk) Information
U.S. Department of Labor, Office of Workers' Compensation Programs (OWCP)
Workers Compensation and HIPAA