Industrial Commission Medical Specialist Resources

Specialist Examiner Credentialing

1.1 Requirements

Prerequisite to temporary appointment, specialists examining on behalf of the Industrial Commission (IC) must have the following credentials:

  1. A current unrestricted license to practice issued by the appropriate state licensing board.
  2. Specialty Certification:
    • Medical Doctor (M.D.)--board certification as recognized by the American Board of Medical Specialties
    • Doctor of Osteopathy (D.O.)--board certification as recognized by the American Osteopathic Association
    • Chiropractor (D.C.)--diplomate status in Orthopedics, Neurology, Internal Disorders, Sports Medicine or Occupational Health
    • Psychologist (Ph.D., Psy.D., Ed.D.)--three years experience in Health Psychology or Behavioral Medicine, or one year post doctoral training and two years clinical experience in Health Psychology or Behavioral Medicine
    • Doctor of Dental Surgery (D.D.S.) or board certification in Oral and Maxillofacial Surgery
    • Podiatrist (D.P.M.)--diplomate status by the American Board of Podiatric Surgery
  3. No suspension, public reprimand, or probation from professional practice within the past five years.
  4. The specialist must maintain at her/his expense, professional liability insurance of $1,000,000 per Incident and $1,000,000 per annum.

Prerequisite to provisional appointment, specialists examining on behalf of the Industrial Commission (IC) must have the following credentials:

  1. A current unrestricted license to practice issued by the appropriate state licensing board.
  2. Specialty Certification:
    • Medical Doctor (M.D.)--board certification as recognized by the American Board of Medical  Specialties
    • Doctor of Osteopathy (D.O.)--board certification as recognized by the American Osteopathic Association or the American Board of Medical Specialties  
    • Chiropractor (D.C.)--diplomate status in Orthopedics, Neurology, Internal Disorders, Sports Medicine or Occupational Health
    • Psychologist (Ph.D., Psy.D., Ed.D.)--three years experience in Health Psychology or Behavioral Medicine, or one year post doctoral training and two years clinical experience in Health Psychology or Behavioral Medicine
    • Doctor of Dental Surgery (D.D.S.) or board certification in Oral and Maxillofacial Surgery
    • Podiatrist (D.P.M.)--diplomate status by the American Board of Podiatric Surgery
  3. Unrestricted eligibility to participate in Medicare and Medicaid programs.
  4. No suspension, public reprimand, or probation from professional practice within the past five years.
  5. The specialist must maintain at her/his expense, professional liability insurance of $1,000,000 per incident and $1,000,000 per annum.
  6. The specialist must have two years of full time, clinical practice experience in her/his specialty.
  7. The specialist must document eight hours of continuing medical education credits (CME) within the past five years, specific to impairment rating.
  8. The specialist must practice direct patient care in her/his specialty at least eight hours per week on a recurring basis for forty weeks per year or have had an active clinical practice or office practice of at least five years duration voluntarily closed within the past seven years.

1.2 Recruitment

Designated Medical Section personnel wil contact the needed specialist by telephone. If there is interest on the part of the specialist, a letter and application are sent from the Medical Section to initiate the credentialing process.

1.3 Temporary Appointment

Temporary appointment is an internal Medical Services function that facilitates utilization of a needed specialist. This designation is meant to fill an immediate need of the Industrial Commission for an examination by an out-of-state specialist, or infrequently used in-state specialist. The specialist’s application for temporary approval is received from the specialist and reviewed by the Deputy Director of Medical Services then input by the Administrative Assistant into the Commission Adjudication System (CAS) Provider Review System (PRS). 

Designated Medical Services Personnel:

  • Verifies the specialist's State issued license and Board Certification.

If the specialist meets the requirements for temporary appointment:

  • Sends the specialist a temporary approval letter, and the web address for IC Medical Examination Manual (hard copy will be sent upon request).
  • Notifies medical scheduling and regional medical staff of the addition of the new temporary specialist by memorandum.
  • Enters specialist data on the CAS Provider Review System, enabling all internal CAS users to access basic provider information for inquiry or search.
  • Files the information received from the specialist in her/his credentials file.

If the specialist does not meet the requirements, the specialist/office is notified.

The status of temporarily appointed specialists is reviewed periodically by the Deputy Director of Medical Services. If the specialist’s services are not required again within a two year period, the specialist is removed from the Provider Review System (PRS). If the specialist’s services are required more often than ten times per year, then she/he will be required to apply for provisional appointment.

1.4 Application and Non Verification by Practitioner Credential Verification Center, LLC (PCVC)

When it is determined that there is need for a particular specialist in a region of the state to serve the long term needs of the Industrial Commission Medical Section, the interested specialist is sent a packet of application information by designated Medical Services personnel. The packet includes a cover letter, application for provisional appointment, and release of information forms for malpractice coverage and PCVC .

Applicant (specialist) credentials are verified by PCVC upon receipt of a completed application for provisional appointment to Ohio Industrial Commission Specialist panel and signed release forms as described above. The completion of this process by PCVC can take several months, depending upon response time from primary sources. The fee for this service ($175) is the responsibility of the applicant (specialist).   

If PCVC fails to verify the specialist application, the Deputy Director of Medical Services will:

  • Send a letter to the specialist stating we are unable to approve the appointment to the IC Medical specialist panel.

1.5 Provisional Appointment Process and Documentation

The completed application, and verified supporting documentation is forwarded to Medical Services by PCVC.  These documents are reviewed by the Chief Medical Advisor (CMA) for recommendation of appointment to the Industrial Commission’s Provisional Specialist Examiners panel.

If the specialist is provisionally appointed, designated Medical Services personnel:

  • Sends the specialist a letter of provisional appointment and if requested a hard copy of the IC Medical Examination Manual.
  • Notifies medical scheduling and regional medical staff of the new provisionally appointed specialist by memorandum.
  • Enters the specialist data on the CAS Provider Review System enabling all internal CAS users to access basic provider information for inquiry or search.
  • Schedules an appointment with the specialist for orientation with the Deputy Director and Chief Medical Advisor (CMA).

If the specialist is not appointed, designated Medical Services personnel:

  • Notifies the specialist/office.    

1.6 Advancement of Appointment to the Specialists’ Panel

During the first twelve months of provisional appointment:

  • Examinations will be assigned to specialist at a rate of no greater than two per month, starting after orientation.
  • The reports of these examinations will be reviewed by the Deputy Director of Medical Services and the Chief Medical Advisor.
  • When opportunities for education, improvement of reports, and improvement of the examination process present themselves, these will be discussed with the specialist.
  • If, at the end of the provisional period, the specialist’s responses to educational efforts, reports, and examinations meet acceptable quality standards, then recommendation will be made by the Chief Medical Advisor for appointment to the Industrial Commission Specialist Examiners panel.
  • If appointed, the specialist is sent a letter of active status appointment.
  • If, at the end of the provisional period, the specialist’s response to educational efforts, reports, and examinations do not meet acceptable quality standards, or if, there is no longer felt to be a need for the specialist’s services, then recommendation will be made by the Chief Medical Advisor not to advance the specialist to the IC Specialists panel, and the specialist is sent a letter unable to approve advancement to active status.

1.7 Reappointment

After five years of service on the panel, the specialist will be required to attest to continued compliance with the requirements for appointment, and provide documentation of CME credits earned as outlined in section 1.1 above.

  • If at the time of application for reappointment the specialist is found to be in continual compliance with the requirements for appointment, and there is still felt to be a need for the specialist’s services, and if, at the end of the reappointment period, the specialist’s responses to educational efforts, reports, and examinations meet acceptable quality standards, then recommendation will be made by the Chief Medical Advisor (CMA) for reappointment to the Industrial Commission Specialist Examiners panel.
  • If reappointed, the specialist is sent a letter of active status appointment.
  • If, at the time of application for reappointment, the specialist’s response to educational efforts, reports, and examinations do not meet acceptable quality standards, or if, there is no longer felt to be a need for the specialist’s services, then recommendation will be made by the CMA not to advance the specialist to the IC Specialists panel, and the specialist is sent a letter unable to approve active status. The specialist status is changed to “Inactive.”
  • The specialist is given 14 days from date of receipt of reapplication packet to complete and respond.
  • If no specialist response is received, a second attempt letter is faxed (14 days) to obtain the information.
  • If no information is received from the specialist within the stated timeframes the status is then changed to “Inactive.”

1.8 Removal from the specialists’ panel

The participation of a specialist on the medical specialist panel is at the sole discretion of the Commission.

If the Commission determines that there is no longer a need for the participation of a specialist on the medical specialist panel designated Medical Services personnel will send written notification to the specialist that the Commission is unable to extend appointment to the medical specialist panel. 

If at any time during active status, a specialist’s examinations, reviews, or reports do not meet acceptable quality standards as determined by the Chief Medical Advisor or/and the specialist’s responses to educational efforts undertaken by the Commission fail to cure identified deficiencies, the Chief Medical Advisor will recommend that the specialist be removed from the medical specialist panel. 

If it is deemed necessary the Industrial Commission Quality Committee will convene to review the assertion that a specialist’s examinations, reviews or reports fail to meet acceptable quality standards and the Quality Committee will advise as to further appropriate action.

Should the Commission determine that a specialist be removed from the medical specialist panel designated Medical Services personnel will make written notification to the specialist of the removal of the specialist from the medical specialist panel. 

 

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