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Orthopaedic & Rehabilitation Institute

Policy

Accepted Workers’ Compensation Insurance

We accept Pennsylvania, US Department of Labor, Ohio, and West Virginia workers’ compensation.

  • The Workers’ Compensation Law in Pennsylvania does not require pre-authorization of medical treatment, therefore, our office will not pre-certify visits, diagnostic testing, physical therapy, durable medical equipment, or surgery.
  • US Department of Labor, Ohio, and West Virginia medical treatment will be pre-authorized as required by those governing bodies.
     

Scheduling an Appointment for a Work-Related Injury

Please be prepared to provide the following information when scheduling an appointment for a work-related injury:

  • Name of insurance carrier or self-insured employer Per the Pennsylvania Workers’ Compensation Law, we are not permitted to bill employers who are fully insured.
  • Billing address and phone number
  • Claim number and/or social security number
  • Date of injury
  • Injured body part
  • Employer name, address, and phone number
  • Patient’s address, phone number, and date of birth
  • Secondary insurance
  • Secondary insurance is requested for the patient’s protection. We will not bill secondary insurance unless the workers’ compensation insurance company has denied the claim.
     

Nurse Case Manager/Rehabilitation Specialist Information

Nurse case managers are welcome to schedule appointments to meet with our physicians.

  • Please call our scheduling office at 1.877.660.6777 or 412.359.3895 to schedule an appointment. An appointment must be scheduled in advance.
  • Payment for your visit is collected at the time of service.
  • We must permit the patient to decide whether he or she permits the nurse case manager to meet with the physician.
     

Reporting

A standard Allegheny Orthopaedic Associates Work Capabilities Report will be completed after every physician visit. This form includes the diagnosis, treatment plan, work status, and follow-up visit information.

  • Forms submitted which are replacements for the Work Capabilities Report will be disregarded and a standard Work Capabilities Report will be completed in its place.
  • Please contact the Workers’ Compensation Department at 412.359.8150 regarding any additional forms requiring completion. Forms other than the Work Capabilities Report which are not required by State or US Workers’ Compensation Law may be subject to the individual physician offices’ fee schedule, and pre-payment is normally required.
  • Please contact the Workers’ Compensation Department via phone at 412.359.8150 or via fax at 412.359.8551 to provide the appropriate contact information for the person who is to receive the Work Capabilities Report.
  • The Work Capabilities Report is faxed to the designated contact person within 24 hours of the appointment.
  • The patient always receives a copy of the Work Capabilities Report.
     

Medical Records

  • Medical records are mailed with the bill to the insurance carrier or self-insured.
  • Operative reports, diagnostic studies, and physical therapy notes will not be faxed by our office (only our office notes when applicable).
  • If you choose to request the records from our office, you must do so by submitting a faxed request with proper authorization (charges may apply). Records requests will be handled by the individual physician office.
  • Most visits 90 days post-operatively do not generate bills; therefore, medical record requests can be made and fulfilled at no charge.
     

Panel Participation

  • We are honored to participate on employer’s panels or as recommended by insurance carriers.
  • Please contact our Workers’ Compensation Manager for approval prior to placing our physicians on an employer’s panel so that we can verify any specific employer needs.
  • Kindly provide a copy of the panel and notification of the current insurance carrier. You may fax the panel to 412.359.8551 or email the panel to aoaworkmencomp@wpahs.org.
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