Latest With OnBoard PARs

On 7/26/2023, the Board held a webinar to provide updates and answer questions.

PAR Highlights

• If the wrong PAR type is submitted by the provider, it is acceptable to deny and explain why in the response.
• However, in a scenario where an MTG Confirmation PAR is submitted but the payer believes it really should be a MTG Variance, a medical necessity review should still be completed. The provider may truly believe that the request falls within the MTG.
• If a surgery is already approved through a PAR response and another PAR comes in with additional requests added to the surgery, you cannot use an administrative denial - it must be reviewed. If you’ve already approved it, you must approve it again but you may reference the PAR ID where the original approval was made.
• A physician that already completed an IME for an injured worker may also review a Level 2 request.? However, the Board does look at multiple physician reviewer opinions more favorably than the same physician doing both an IME and Level 2 review.
• If a PAR is received but sent to the wrong carrier, the fastest way to get their attention is to controvert the claim and also send notice directly to the Board.

Broader Updates

• The Board is currently working on system API capabilities which will provide major process efficiencies for payers handling a high volume of PARs
• It does appear that the ability to grant without prejudice at Level 1 will be implemented in OnBoard, however, a date has not yet been released.