| Virginia WORKERS COMPENSATION COLLECTION PUBLICATIONS AND INFORMATION FOR MEDICAL PROVIDERS |
 |  |  |  |
| General Information |
| Publications |
| Work Comp News and Issues |
- Medical Control
The injured employee must select a doctor from a panel of medical providers established by the
employer/insurer. If a panel is not offered, the injured employee may seek treatment from any
medical provider. The treating provider may refer the injured employee to other medical
providers. Once treatment begins, the injured employee may not change providers without the
approval of the employer/insurer. The employee may select his/her own pharmacy or select a
pharmacy from the Express Scripts pharmacy network. Emergency medical care does not
require preapproval and should be secured at the nearest location.
- State Fee Schedule
There is no fee schedule in Virginia. Charge schedules agreed to by the carrier and provider will
be enforced.
If a dispute arises as to reimbursement for a medical charge, the health care provider may invoke
one or more of the following remedies:
Adjudication Requirements
Appropriate where there has been no payment or where provider is dissatisfied with level of
reimbursement Initial decision issued by a deputy commissioner after reviewing evidence
Right of review by the Commission Appeals to Virginia Court of Appeals and Supreme Court
of Virginia Initiated by filing a request along with supporting evidence to the Commission When
filling a request with the Commission to resolve a dispute over payment for medical services
rendered to an injured worker you must:
Send a copy of your submission to the Commission and all interested parties. These parties
may include the insurance carrier or self-insured; the third party administrator if one has been
assigned by the carrier or self-insured; the attorney for the latter parties; and the injured worker
and his/her attorney.
Your submission must include: the medical bills and treatment reports which are in dispute; the
actual balance you are seeking; and the dates of services.
Failure to provide copies of your submission to all interested parties and/or supporting
information regarding your claim may result in rejection.
For further information on these and other requirements, please call (877) 664-2566.
Mediation
Mediation may be requested in addition to Adjudication.
Informal, cost-effective means of alternative dispute resolution
Parties design their own solutions with the help of a Commission mediator
Parties agree to mutually satisfactory solution
Appropriate for any medical charge issue
Initiated by written request filed with Commission in letter format or using our mediation
request form.
Once the claimant has filed a claim which covers a specific charge, or once the Commission
enters an award of compensation applicable to a charge, the health care provider may not
attempt to bill the claimant for any part of the charge. However, if the Commission rules that
the charge is not compensable under the Act, the provider may bill the claimant.
For more information on this last point, see Sections 65.2-601.1 and 65.2-714 D of the Code of
Virginia.
Health care providers may check the claims status for their patients by calling the Commission
toll-free at 1-877-664-2566. Multiple inquiries may be sent by facsimile to (804) 367-0142 or
by mail the Commission's Medical Care Provider Inquiry typeable form or on similar format.
The Medical Care Provider Specialist provides wrokers' compensation claims information to
medical care providers. The Medical care Provider Specialist also assist providers with disputes
over non prayment and underpayment of treatment by contacting appropriate parties and
facilitating resolution.
HIPAA privacy regulations do not apply to workers' compensation. To learn more, please click
on HIPAA.
The Commission has several articles that further discuss some important issues.