Designated Treating Provider/Worker Status Form
Providers who have accepted Montana State Fund’s designation of “Treating Physician” (refer to Montana Code Annotated 2011 39-71-1101) must complete a Medical Status Form at each visit with an injured worker. This form may be downloaded from montanastatefund.com. (You will find the form under the Help Me Find section on the right hand corner of the homepage).
Per Montana ARM, the responsibilities of the designated treating provider include:
- Coordination of all medical care;
- Providing timely determination of Maximum Medical Improvement (MMI), return to work, work restrictions, job analyses, etc;
- Providing or arranging for treatmet within the utilization and treatment guidelines;
- Conducting or arranging for timely impairment ratings;
- Submission of necessary documentation to include the office notes and Medical Status form after each office visit.
A designated treating provider is paid an additional 10% over fee schedule for the completion of these duties. Please reference the FAQ’s on the Montana State Fund or Department of Labor & Industries websites listed on the Points of Contact section of this newsletter.