4.5.33.5 Pain management programs
Follow these steps when a request for a Pain Management Program is received.
Note: These work practices are related to Pain Management Programs only and do not apply to Network Pain Management Programs.
| Step | Agent action |
|---|---|
| Receive request for assessment |
Following a referral from a medical practitioner, the Pain Management Program provider should submit a request for a pain management program multidisciplinary assessment to the Agent. Place a copy on the worker’s file. If the medical practitioner sends the referral to the Agent but does not refer directly to a program, contact the medical practitioner to discuss. The medical practitioner, with the worker, should select an appropriate program based on the workers location and needs. |
| Review request |
The Agent reviews the request for a pain management program assessment and the worker’s claim file information to determine whether liability for a Pain Management assessment should be accepted. Liability issues This review should confirm that there is a relationship between the Pain Management program and the work-related injury or illness. The review may include:
Further information or assistance required Where there are liability issues, the Agent should discuss what further information is required and acknowledge the request in writing (letter PM1) within five working days. |
| Determine liability |
When no further information is required the Agent needs to make a decision to accept or reject liability for the initial assessment for the program within five days. Please note: A report will be required from the Pain Management provider following the initial assessment. This report should detail the outcomes of the assessment and any recommendations, including details of the Pain Management program, if required. Further approval is required from the Agent if services are recommended following this assessment. |
| Request for pain management program |
Following the pain management program assessment, when a request for a pain management program has been received, the Agent should document this request in Novus. Information to be recorded includes:
A copy of the request is placed on the worker’s claim file. Further information or assistance required Following the discussion, the Agent should determine if further information is required and acknowledge the request in writing (letter PM1) within five working days. If further information is required, a telephone call to the referring medical practitioner, Pain Management provider or worker should occur within 10 working days of receipt of the request. Information received should be reviewed and documented within five days of receiving the further information. When no further information is required the Agent needs to make a decision to accept or reject liability for the pain management program. Liability accepted Where there are no liability or reasonableness issues, the Case Manager should send an approval letter (PM4) to the worker (with a copy to the Pain Management provider and medical practitioner) within five working days. Please note: A report should be received from the Pain Management provider on completion/discharge from the pain management program. This report should detail the outcomes of the program and any recommendations. Liability rejected Where there are liability issues or the request for further information does not support the Pain Management assessment, the Case Manager should complete the sound and proper decision making process within five working days. |