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Workers' Compensation MCU
Certified Provider Program
- What are the benefits of becoming a certified provider?
- How does a provider apply for certification?
- How can employers verify that a provider is certified?
- Can employers require employees to treat with certified providers?
- What is the Certified Provider Program in Delaware Workers’ Compensation?
- Who is eligible to become a certified provider?
- What happens if a provider’s certification expires or they do not follow the guidelines?
Health Care Payment System (HCPS) & Fee Schedule
- What is the Delaware Health Care Payment System (HCPS)?
- When is preauthorization required?
- How does the HCPS fee schedule control medical costs?
- What billing rules must providers follow?
- When must carriers pay, reduce, or deny a medical bill?
- What documentation must accompany a bill?
- What happens if a provider’s charges exceed the fee schedule?
Treatment Guidelines & Utilization Review (UR)
- What does “presumption of reasonableness” mean?
- What deadlines apply to UR requests?
- What happens after a UR decision is issued?
- What are the Delaware Workers’ Compensation treatment guidelines?
- How do the guidelines apply to certified vs. non-certified providers?
- When can treatment deviate from the guidelines?
- What is Utilization Review (UR)?
- When can an employer or carrier request UR?