Frequently asked questions -- certified managed care

Questions

1. What is workers' compensation certified managed care?

2. How do I know if I am covered by a certified managed care plan?

3. What is the process for resolving disputes under a certified managed care plan?
Workers' compensation certified managed care is expected to reduce the number of disputes that arise in workers' compensation, by encouraging quality treatment, communication between the parties and appropriate return to work. However, if there is a difference of opinion about a medical issue related to managed care, the workers' compensation law requires that each certified managed care plan must try to resolve the dispute.

An employee or health care provider may start this process by submitting a written complaint to the managed care plan; some plans will also accept complaints by telephone. The plan must respond to the employee or health care provider within 30 days after receiving the complaint.

If an employee or health care provider is not satisfied with the response from the managed care plan, or if the managed care plan does not respond to a written complaint within 30 days, the employee or provider may file a Medical Request form with the Department of Labor and Industry.

A copy of the written complaint that was submitted to the managed care plan, or other documentation that the managed care plan's dispute process has been completed, must be attached to the Medical Request form. The managed care plan's response may also be attached, but this is not required.

The requirement that a dispute must be submitted to the managed care plan first applies only if an employee is covered by a certified managed care plan.

4. Can I get a list of certified plans?

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If you don't see your question answered here or want more information about certified managed care, contact the Minnesota Department of Labor and Industry at (651) 284-5005, toll-free at 1-800-342-5354 or TTY at (651) 297-4198.