Illinois Preferred Provider Program

1. Illinois Preferred Provider Program Employer Information April 2013

2. Illinois WC Reform – HB 1698 • HB 1698 is a workers’ compensation reform bill signed by Governor Quinn in June 2011. This legislation gives employers more control of medical care delivered to injured workers through a Preferred Provider Program (PPP). The final rules were adopted in March 2013. • HB 1698 also revised the medical fee schedule; introduced AMA guidelines as a standard in determining disability; established Utilization Review guidelines; provided for electronic claims submission; established wage differential, provider payment timeframes and Carpal Tunnel Syndrome payments and guidelines.

3. IL Preferred Provider Program (PPP) • A PPP is a network of medical care providers contracted for treatment of work-related injuries and illnesses. • A PPP is required to have adequate choice of medical providers within a reasonable distance from the injured worker’s residence. • The Hartford has an agreement with Coventry Health Care Corporation to access Coventry’s approved PPP. You may access PPP provider lists and information at http://www.talispoint.com/htfd/external/, or call our Network Referral Unit at 1-800-327-3636, prompt #4. • The Act allows direction of medical care within the PPP, provided the appropriate notification to the injured worker (IW) has occurred and the IW has not declined participation in the program*. Note: If the employee does not want to use the PPP, he or she must inform the employer in writing. The employee can then go to one other medical provider and that provider's chain of referrals.

4. PPP Network Access Requirements • Primary treating and hospital health care services for emergency services are within 30 minutes or 115 miles of each covered employee’s residence. • Occupational health services and specialist providers are within 60 minutes or 30 miles of a covered employee’s residence. • Appointments for initial treatment are available within three business days after the carrier’s receipt of a request for treatment within the PPP. Specialist appointments must occur within twenty business days after the carrier’s receipt of a referral to a specialist within the PPP.

5. Your Role • Deliver the Notice of Preferred Provider Program to all employees. This step is optional, but recommended by The Hartford to help ensure program acceptance. • Provide, at time injury or when the IW files a workers’ compensation claim, the IW with the Illinois Workers’ Compensation Commission-approved, mandatory PPP notification form.This form explains the PPP and contains information on how to access a list of PPP providers via Hartford’s Online Provider Search tool or the Network Referral Unit via phone. These forms are available online at http://www.thehartford.com/il-workers-compensation. • Obtain the IW’s signature on the notification form. Maintain a copy of the signed form in employee’s file, and any written correspondence regarding employee’s intent to opt out. Please share this form/information immediately with the claim handler. • Keep a list of local PPP clinics and providers on hand. You may obtain lists online at http://www.talispoint.com/htfd/external/, or call our Network Referral Unit at 1-800-327-3636, prompt #4 to obtain a list via immediate email, or, upon request mail/fax.

6. Employee Opt Out Information • If IW opts out of the PPP in writing, the IW forfeits one of the choices he or she is allowed to make when selecting a provider to treat the injury/illness. • An IW who opts out of his or her employer’s PPP in writing only has one change of treating provider remaining • If IW exercises that choice, any further change will be at the employer’s discretion, including directing that IW for treatment with a PPP provider

7. Out of Network Medical Treatment Out of network treatment may be authorized for: • An IW who requires treatment that is not available within the PPP. If it is it medically necessary to refer an IW to a non-preferred provider, The Hartford will ensure that the IW shall incur no greater liability than had the IW received services from a preferred provider, except as provided pursuant to Section 8.1a(c)(2) and Section 8.2(e) of the Workers' Compensation Act, without any loss of provider choice under Section 8 or 8.1a(c) of the Workers' Compensation Act; • An IW who you have authorized to temporarily work or travel for work outside the PPP geographic service area when the need for medical care arises; • A former employee for whom you have ongoing workers’ compensation obligations and who permanently resides outside the PPP geographic services area; and • An IW who decides to temporarily reside outside the PPP geographic service area during recovery.

8. Change of Physician • Except as provided in 820 ILCS 305/8(a)(4), upon a finding by the Commission that the care being rendered by the employee's second choice of provider within the employer's PPP is improper or inadequate, the employee may then choose a provider outside of the PPP at the employer's expense. • The Commission shall issue a decision on any petition filed pursuant to this Section within five (5) working days.

9. Helpful Links • To find PPP providers near your workplace or injured workers’ residence, access the Online Provider Search at http://www.talispoint.com/corp/index.html • To download necessary forms and read more about the PPP, go to The Hartford’s IL PPP website at http://www.thehartford.com/il-workers-compensation • To learn more about workers’ compensation in IL, access the Handbook on Workers’ Compensation and Occupational Diseases at http://www.iwcc.il.gov/handbook013013.pdf. • To access required and suggested forms: http://www.iwcc.il.gov/forms.htm. • PPPPreferred Provider Program Mandatory Notice (10/11)Word • Preferred Provider Program Mandatory Notice in Spanish (10/11)Word • Preferred Provider Program Advisory Notice (10/11)Word • Preferred Provider Program Advisory Notice in Spanish (10/11)Word