| *All of our physicians are certified as DESIGNATED DOCTORS by TDI-DWC.
Physician Peer Review
Peer reviews are an excellent tool for the adjuster in determining a reasonable course of action. MEI’s board certified specialists review/address issues and specific questions using the most current evidence based medical rationale.
7 day turnaround
Impairment Rating Review
Independent review of impairment rating ensures it meets the standard of the 4th Edition of the Guides, the statute, the rules, and any applicable Appeals Panel decisions. The reports are provided within 48 hours assisting the adjuster in meeting the division mandated timeframes, thus eliminating unnecessary financial exposure.
Required Medical Exam
Board-certified specialists conduct Required Medical Examinations (RME) to the same high standards that control the Designated Doctor examinations. Assessments are clear, concise and accurate. Impairment ratings are conducted under the provisions of the 4th Edition AMA Guides to the Evaluation of Permanent Impairment.
Early Compensability Assessment (ECA)
The ECA is a great tool utilized early in the claim. It reviews the mechanism of injury; the findings at the time of the first examination, and assesses what is, and what is not part of the compensable injury.
Claim File Analysis (CFA)
CFA provides a comprehensive medical record review; listing all disputes (per PLN-11), a full medical time line, return to work history (per DWC 73), previous DDE’s and RME’s, and a list of references including the ODG, MDA and Impairment guides. As noted in the rule, the designated doctor is required to read the summary.
Designated Doctor 32 Processing
Medical records are placed in chronological order and summarized in accordance with selected goal oriented questions. The records and report are provided to the Designated Doctor in a prompt and efficient manner.
Physician Pre-Authorization
This service is a direct support to your pre-authorization system. It determines medical necessity and the appropriateness of the proposed treatment, level of care, length of stay and appropriate treatment setting. Pre-authorization is also used to identify members for case management or disease management programs.
Pre-authorization addresses medical necessity only and does not guarantee payment. It is not a treatment recommendation or a guarantee that your patient will be insured or eligible for benefits when services are performed. The pre-authorization process is not complete until patient benefits and eligibility have been verified.
To Request Pre-authorization
Cases may be submitted either by email at Intake@medicalequation.com or by facsimile at (512) 732-0155. In the event that a client requires immediate assistance, phone inquiries may be made by calling (855) 846-1732.
Consumer rights and responsibilities for Texas utilizations review are kept up to date as part of the Texas Administrative Code (TAC) by the Texas Secretary of State. A full copy of the Texas Administrative Code may be found at: http://info.sos.state.tx.us/pls/pub/readtac$ext.viewtac
Utilization Reviews are specifically referred to in 28 TAC, Part 2, Chapter 134, Subchapter G – RULE §134.600 - Prospective and Concurrent Review of Health Care: Click Here for more information (http://info.sos.state.tx.us/pls...)
EMG Review
EMG Test findings are reviewed to insure that the assessment made is consistent with the raw data obtained or presented by the reporting electromyographer. We highly recommend you obtain an EMG Review on all your abnormal EMG findings; as anecdotally, the majority of these EMG’s are incorrect.
Designated Doctor Determination Review (DDDR)
A consultative report comparing the designated doctor’s recommendations with the statute, rules, MDGuidelines and ODG. This independent review is performed by a Board Certified specialist, who is fully licensed in the state of Texas in accordance with HB 1003 regulations.
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