Attending provider guidelines
Definition of attending physician (AP)
A medical doctor, doctor of osteopathy, or oral surgeon qualify as an attending physician and is primarily responsible for:
- Reporting claims
- Directing and managing treatment
- Authorizing time-loss benefits
- Rating impairment
- Commenting on work capacities
A chiropractic physician, naturopathic physician, physician assistant, and authorized nurse practitioner may also qualify as an attending physician for a limited period.
Check this helpful WCD chart to see the treatment rules for the attending physicians listed above and others, such as emergency room physicians and acupuncturists. (The chart does not apply to claims enrolled in an MCO.)
Authorization of referrals
If you have a question about a referral or authorization, please call the adjuster, because the situation is often unique to the status of the claim.
In general | State workers' comp rules do not require SAIF to authorize any referral. SAIF may pay for treatment retroactively if it's compensable under state rules or the MCO contract, if the claim is enrolled in an MCO.
For MCO claims, the MCO will determine if recommended treatment is medically necessary and appropriate, according to their contract with the provider. However, that does not guarantee payment.
Physical therapy and other ancillary services
MCO claims | A claim enrolled in an MCO is subject to the referral provisions of the MCO-provider contract. Any questions need to be directed to that MCO.
Non-MCO claims | A claim not enrolled in an MCO is subject to Oregon Administrative Rules (OAR 436-010-0230(5)(a)).
When the attending physician prescribes physical therapy or any other ancillary service, the ancillary service provider must prepare a treatment plan before beginning treatment. The treatment plan must include objectives, modalities, frequency of treatment, and duration.
That provider must send the treatment plan to the attending physician or NP and insurer within seven days of beginning treatment. If the plan is not sent within seven days, the insurer is not required to pay for the services provided.
In addition, the attending physician or NP must sign a copy of the treatment plan within 30 days of the beginning of treatment and send it to the insurer.
See the "Claim status" page for more on referrals.
Timeframes and services by providers
What kind of treatment can be provided, and for how long, depends on the type of provider. This chart describes the allowable timeframes and services.
Chiropractors, naturopaths, nurse practitioners, and physician assistants must be certified by the Oregon Department of Consumer and Business Services (DCBS) before treating any patients with Oregon workers' comp claims.
This is important, because if you do not become certified by DCBS prior to treating an Oregon injured worker, you will be ineligible for payment of medical services and you cannot authorize time-loss benefits for the injured worker.
More on certification