Medical Resource Office
Jacqueline Kurth, Manager
Email: [email protected]
800 W Washington St, Phoenix AZ 85007
Phone: (602) 542-6731
FAX: (602) 542-4797
Mission Statement: The MRO Office shall provide administrative review and oversight of the implementation of a process for the use of medical treatment guidelines, A. R. S. §23-1062.03. The MRO Office provides staff support to the Commission regarding the Physicians' and Pharmaceutical Fee Schedule, which is evaluated and updated each yea, A.R.S. § 23-908([B).
Treatment Guidelines Information
MEDICAL TREATMENT GUIDELINE PROCESS FLOWCHARTS
MEDICAL TREATMENT GUIDELINE FORMS
Who uses it? Medical Provider and Payer.
Where to File? Medical Provider submits initial request for preauthorization for medical treatment or services to Payer. Within 10 business days of receipt of preauthorization request or reconsideration request, Payer uses form to communicate decision on initial preauthorization request or reconsideration request to Medical Provider, with copies to Injured Employee or Injured Employee's Attorney.
When to File? Medical Provider submits initial request for preauthorization for medical treatment or services to Payer on this form. Medical Provider may also use this form to submit request for reconsideration of Payer's initial decision regarding preauthorization request. Payer uses this form to communicate decision to Medical Provider within 10 business days of receiving request for preauthorization or reconsideration. Payer uses this form to provide notice to Medical Provider that an Independent Medical Examination (IME) has been requested or initial request for preauthorization or reconsideration is incomplete.
Who uses it? Medical Provider, Injured Employee, and Injured Employee's Attorney.
Where to File? Submit directly into the MRO Portal here, FAX to (602) 542-4797, or Mail to Industrial Commission of Arizona, Medical Resource Office, 800 West Washington Street, Phoenix AZ 85007. Please do not send this form (when filled out) as an attachment to an email, because it may contain personal or sensitive information and email is not secure.
When to File? (1) If you disagree with the Payer's reconsideration decision, or (2) The request for reconsideration is supported by the Guidelines, and the Payer's initial decision denied the request, or (3) A Payer failed to communicate its decision on a request for preauthorization within 10 business days. Note. If a Payer obtains an independent Medical Examination (IME) that serves as the basis for his decision, then review of that decision must be requested by the injured employee under A. R. S. § 1061(J).
FEE SCHEDULE INFORMATION
NCCI MEDICAL DATA REPORTS