4.5.33.3 Suitability of the worker
If approved, the Network PM provider arranges a time with the worker to conduct an assessment within 20 working days of receiving approval from the Agent.
Assessment case conference
A multi-disciplinary case conference (via telephone) will be organised by the Network PM provider.
Participants include but are not limited to:
- the worker
- the referring medical practitioner
- the Agent
- at least two medical and/or healthcare providers from the program.
Document notes
The Agent should document notes. Information to be recorded includes:
- worker’s suitability for the program
- any significant issues
- any actions required by the Agent.
The Agent should receive a Network PM Assessment and Treatment Plan Report from the Network PM provider within five working days of the assessment. A copy of the report is placed on the worker’s claim file.
The Agent is to follow up any recommendations made in the Network PM Assessment and Treatment Plan Report and document on Novus the outcomes and recommendations from the report.
Worker is suitable for the NP management program
If the worker is deemed suitable by the Network PM provider to undertake the Network PM program, no further provider approval is required by the Agent before commencement of the program. The Agent should, however, send a confirmation letter to the worker within five working days of receipt of the Network PM Assessment and Treatment Plan Report confirming the program will proceed.
Worker not suitable for the NP management program
If the worker is deemed not suitable for the Network PM program by the Network PM provider, the worker is notified by the Network PM provider and the Case Manager sends a rejection letter to the worker with a copy to the referring medical practitioner. The Case Manager places a copy of the letter on file and the worker does not continue with the program.
4.5.33.4 Monitor & document progress
The Agent monitors and documents the progression of the worker participating in the Network PM program.
Worker does not complete program
Provider
The provider is required to submit an early discharge report within five working days of the worker ceasing participation to the Agent and copies the referring medical practitioner.
Agent
The Agent places a copy of the early discharge report on file.
Discharge letter
Send a discharge letter to the worker with a copy to the referring medical practitioner, within 10 days of receiving the early discharge report from the Network PM provider advising the worker of the reported outcomes of the program. The template for the discharge letter should be used and amended to reflect the individual recommendations made by the network provider.
Documentation
Review the information in the follow up reports and place copies on file. The following should be recorded:
- any referrals made
- any recommendations
- any change in work capacity or functional capacity.
Follow up any recommendations made in the follow up reports.
Worker completes program
Measures and assessment
Persistent pain is best evaluated by examining the ways in which the pain is impacting on the whole person, and it is important that treatment is helping them achieve improvement in their function, and as such the achievement of SMART goals indicates the effectiveness of treatment. A range patient self-reported outcome measures may be administered by their treaters to monitor progress as well, such as: The Brief Pain Inventory (BPI), The Depression Anxiety and Stress Scale (DASS), The Pain Self Efficacy Questionnaire (PSEQ).
Discharge case conference
A discharge case conference (via telephone) will be organised by the Network PM provider before discharge.
Participants include but are not limited to:
- the worker
- the referring medical practitioner
- the Case Manager
- a suitably qualified person (injury management)
- at least two medical and/or healthcare providers from the program.
Agent
Document notes from the case conference. Information that should be documented includes:
- members who participated
-
results of outcome measures
- any significant issues
- any discharge recommendations
- any actions required by the Agent.
Send a discharge report within five working days of the discharge case conference. A copy of the report is to be placed on the worker’s claim file.
The Agent is to follow up any recommendations made in the discharge report and noted.
Discharge letter
The Case Manager sends a discharge letter to the worker with a copy to the referring medical practitioner within 10 days of receiving the discharge report. This letter should outline the reported outcomes of the program provided by the Network PM provider in the discharge report.
4-8 weeks post discharge and 26–30 weeks post discharge
The Network PM provider will provide two follow up services to the worker following discharge from the Network PM program. They will send a Follow Up Report to the Agent within five working days of these services.
Documentation
Review the information in the follow up reports and place copies on file. The following information should be recorded.
- any referrals made
- any recommendations
- any change in work capacity or functional capacity.
The Case Manager should follow up any recommendations made in the follow up reports.
Payment of invoices for network pain management assessment and/or programs
Review the invoice against the services provided on the assessment - discharge or follow up reports within five working days. This is to validate the services delivered are the same as the services invoiced from the Network PM provider.
Once this has been reviewed send the invoice to the payments team for processing and payment.
Where a Network PM program has been approved by an Agent, invoices should be paid within seven working days of receipt.