Medical provider limitations

Chiropractic physicians

MCO chiropractic physicians may act as attending physician and determine work status for 20 visits or 60 days, whichever comes first on the initial claim. Further treatment must be approved by the MCO. The MCO chiropractic physician may continue as attending physician and determine work status as long as care is approved by the MCO.

Qualifying non-MCO chiropractic physicians may act as attending physician for 18 visits or 60 days, whichever comes first, on the initial claim, and may determine work status for not more than 30 days. If further treatment is needed this chiropractic physician must then refer you to an MCO physician or authorized nurse practitioner or a qualifying non-MCO primary care physician.

Naturopathic physicians

MCO naturopathic physicians may act as attending physician for 20 visits or 60 days, whichever comes first, from the first visit to any naturopathic physician or physician assistant on the initial claim, and may determine work status for not more than 30 days. If further treatment/work status determination is needed, the naturopathic physician must refer you to an MCO physician or authorized nurse practitioner or a qualifying non-MCO primary care physician. Naturopathic physicians may not make findings of permanent impairment.

Physician assistants

MCO physician assistants may act as attending physician for 20 visits or 60 days, whichever comes first, from the first visit to any naturopathic physician or physician assistant on the initial claim, and may determine work status for not more than 30 days. If further treatment/work status determination is needed, the MCO physician assistant must refer to his/her supervising MCO physician or another MCO-qualified attending physician. The MCO physician assistant may then participate in your care as a physician extender under the direction of the attending physician. Physician assistants may not make findings of permanent impairment.

Nurse practitioners

MCO authorized nurse practitioners and qualifying non-MCO authorized nurse practitioners may provide compensable medical services for 180 days from the first authorized nurse practitioner visit on the initial claim and may determine work status for not more than 180 days. If further treatment is needed the authorized nurse practitioner must refer to an MCO physician or a qualifying non-MCO primary care physician. If the authorized nurse practitioner is an MCO provider and working with an MCO physician, he/she may continue to participate in your care as a physician extender under the direction of the MCO attending physician. Authorized nurse practitioners may not make findings of permanent impairment.

If your current medical provider has exceeded the time limit he or she can provide care or determine work status, please consider carefully before selecting another provider who may offer care for only a limited time. Only M.D.’s and D.O.’s are not limited. Please call Providence MCO if you have any questions about Medical provider limitations or need assistance finding a qualified attending physician.