Medical Unit

Under the direction of an executive medical director, the Medical Unit performs a variety of services related to delivery of medical benefits in the workers' compensation system. It establishes policy and guidelines for the treatment and evaluation of injured workers. The unit examines and appoints physicians to be qualified medical evaluators (QMEs), who in turn examine injured workers to help determine the level of benefits they receive. It also certifies and oversees groups -- medical provider networks (MPNs) and health care organizations (HCOs) -- that provide care to injured workers. The unit reviews utilization review (UR) plans and handles UR complaints and investigations jointly with the Audit Unit. It also assists the DWC administrative director with other issues affecting providers in the workers' compensation system, such as setting medical fee schedules, and undertakes medical care studies.

Medical treatment networks

• Health care organizations (HCO)
• Medical provider network (MPN)

Med-legal programs

• Qualified medical evaluators (QME)
  • QME competency examination study guide
  • QME competency examination results
    • Oct. 27, 2012 Exam
    • April 28, 2012 Exam
• Medical-legal fee schedule regulations - CA Code Regulations, title 8, §9793-9795
• Medical-legal fee schedule tutorial

Independent bill review

• Independent Bill Review
• FAQs about independent bill review

Independent medical review

• Independent medical review
• FAQs about independent medical review

Official Medical Fee Schedule

• Official medical fee schedule (OMFS)

Medical treatment payment

• e-billing
• Standardized paper billing

Utilization Review

• Utilization review (UR)

Medical treatment guidelines

• Medical treatment utilization schedule (MTUS)

Forms

• Additional panel request - OPTIONAL for use when requesting an additional QME panel - under QME regulation 31.7
• Replacement panel request - OPTIONAL for use when requesting a replacement QME panel - under QME regulation 31.5
• How to serve your report on DEU and be EAMS compliant
• more QME forms

Reports

• Adapting the RBRVS Methodology to the California Workers’ Compensation Physician Fee Schedule Dec. 2008
  • Adapting the RBRVS Methodology to the California Workers' Compensation Physician Fee Schedule: Supplemental report March 2010
• Adapting the RBRVS Methodology to the California Workers' Compensation Physician Fee Schedule May 2008
• California Worker's Compensation RBRVS Study The Lewin Group Oct. 8, 2002

Medical Unit office

Telephone Number: 510-286-3700 or 800-794-6900

PLEASE NOTE: ALL PACKAGES, CERTIFIED MAIL AND PRIORITY MAIL MUST BE SENT TO THE STREET ADDRESS ONLY

What's New

May 2013