International Association of Industrial Accident Boards and Commissions (IAIABC)
Kansas Insurance Department
Workers Compensation and HIPAA
Centers for Medicare and Medicaid Services (CMS)
Medicare Information Resources
Medicare Set-Aside Arrangement Reference Guide November 6, 2013
The following sections of the Guide have been enhanced or added:
- 220.127.116.11 – 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.
- 18.104.22.168 – Prescription Drug Review: Details the process the WCRC follows in reviewing prescription medication allocations and the resources that may be used.
- 22.214.171.124 – 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.