Pinnacol Assurance SelectNet Provider Manual.
Changes to the 2021 manual include:
- Urgent care participation standards and referral instructions (Appendix A, page 4)
- Process used to address quality of service and quality of care concerns (Appendix D, page 11)
Changes to the manual in 2020 included:
- DOWC accreditation changes for nurse practitioners (section 2, page 4)
- Notification for rescheduled or cancelled demand appointments (section 3, page 7)
- Electronic billing vendors – contact information updated (section 5, page 5)
- Appeal process added to billing process (section 5, page 7)
- Documentation and turnaround time changes to close claims (Appendix A, page 3)
- ~Indemnity (lost time) claims with no impairment: The WC164 form and office notes must be received within seven calendar days from the date of maximum medical improvement MMI).
- ~Indemnity claims with impairment: The WC164 form and office notes must be received within 14 calendar days from the date of MMI. If the impairment rating is referred to a SelectNet provider who has not previously treated the injured worker, the acceptable time frame between MMI and receipt of the rating by the Pinnacol claims staff is 30 calendar days from the date of the referral.
- ~If a full duty release is prior to the determination of MMI, inform the employer and send records to Pinnacol as quickly as possible.
- ~If the injured worker is unable to return to full duty, the MMI report should clearly state the permanent restrictions.
- Delegation of services and referrals for psychological services providers (Appendix A, pages 8-9)
Effective Jan. 1, 2021, denial of prior authorization requests will be provided in writing to all parties within ten days from receipt of the provider’s complete request in accordance with the 2021 DOWC Rule 16.
The SelectNet Provider Manual is a resource for providers and clinic staff who need to access information about working with Pinnacol and following the requirements of the Workers’ Compensation Act of Colorado.
The manual defines key responsibilities and requirements for clinics and providers participating in SelectNet and Pinnacol’s responsibilities in working with SelectNet providers.
This manual was developed by Pinnacol Assurance and is intended solely for the use of Pinnacol Assurance and Pinnacol Assurance's preferred provider network, SelectNet.