- Conducts medical mediations, medical services reviews, and renders
opinions or recommendations on disputed issues between parties.
- Educates parties regarding their rights under Code of Alabama, 1975, §25-5-77,
and the Utilization Management and Bill Screening Administrative Rules.
- Facilitates resolutions of medical reimbursement issues between payers
and medical services providers.
- Investigates complaints regarding medical services.
- Develops the Alabama Workers' Compensation Maximum Fee Schedule/Prevailing
Reimbursement.
- Manages the Utilization Management and Bill Screening Rules program.
- Serves as administrative assistant to the Workers' Compensation Medical
Services Board and each medical provider advisory committee.
- Manages the Drug-Free Workplace Program.
- Compiles statistics on the number and type of workers' compensation
claims.
- Coordinates electronic data interchange program.
Code of Alabama, 1975, §25-5-77(i), provides that "Any party,
including a health care provider, is entitled to review by an ombudsman
of medical services that are provided or for which authorization of payment
is sought..." To initiate this process the party may contact the
Workers' Compensation Division, Medical Section at 1-800-528-5166. A
member of this section may discuss the dispute with you and perhaps resolve
concerns over the phone. However, the majority of the disputes will require
written communications between the Division and the involved parties.
The following documentation may be required for processing of any dispute:
- The name, address, and phone numbers of the parties involved in the
dispute;
- A written narrative of the dispute;
- Copies of all medical bills (claim forms) and supporting documentation;
and/or
- Documentation of oral communications and copies of written communications
between parties.
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