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 year.
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).
Peer Review Vendors
ANNUAL REVIEW, RE-CERTIFICATION, AND RESUBMITTAL OF QUALIFIED VENDORS
The Industrial Commission of Arizona has postponed the acceptance of qualifications for new Medical Peer Review vendors. The Commission will notify the public at such time when new vendors may submit proposals for the Medical Peer Review process. Administrative Review by the Commission per R20-5-1311 became effective October 1, 2016. If you have any questions regarding this process please contact Janine Locke at [email protected] or by phone at (602)542-8238.
The following vendors meet the requirements for recertification and remain on the Qualified Vendor list:
- CompPartners, Inc.
Each vendor shall be required to submit accreditation and proof of insurance on an annual basis to remain on the Qualified Vendor List. The Commission reserves the right to remove any vendor at any time who becomes unable to continue meeting all requested requirements.
The current fee schedules for Medical Peer Review are as follows:
- Expedited Reviews
Up to 60 pages: $325
Up to 199 pages: $400
Over 200 pages: $550
- Standard Reviews
Up to 60 pages: $250
Up to 199 pages: $325
Over 200 pages: $475
(Medical Peer Reviews terminated or dismissed before forwarding to a medical professional reviewer: $100)
(Medical Peer Reviews terminated or dismissed after forwarding to a medical professional reviewer: $250)
FEE SCHEDULE INFORMATION
NCCI MEDICAL DATA REPORTS