Provider Resources

State Resources

Most Coventry documents are stored on our provider portal. You can find more direction and clarification on specific states at the links below.

State-Specific Information

In addition to information stored on our coventryprovider portal, the following links are provided on key states where Coventry offers network programs.

  • Fully bundled program: Coventry acts as either the certified entity or the support for a client's certification by supplying all the services under the MCO regulations.  We provide fully bundled MCO services in the following states: AR, CA, CT, FL, GA, IL, KY, NH, NJ, NY, OK, SD, TX, and WV.
     
  • Network only program: Coventry provides all appropriate network documentation to support a client's certification.  We provide network-only MCO services in the following states: AR, CA, CT, FL, GA, IL, KY, MA, NH, OK, TX, and WV.
     
  • See the state links below to access more information where appropriate.

    Arkansas

    The Arkansas Provider Reference Manual and MCO documents can be found at coventryprovider.com.

    DWC Offers Free Online Access to Evidence-Based Treatment Guidelines

    Click here for more information.  

    New Laws Affecting Opioid Prescriptions in California in effect 1/1/19

    AB2760 – requires opioid prescribers to offer a prescription for naloxone (an overdose-reversing drug) if specific circumstances are met including:  Opioid prescribed is 90 MME+ per day, or prescribed in combination with a benzodiazepine, or to an individual at risk for overdose.  Click here for more information/details.

    California Drug Formulary

    The California Department of Industrial Relations’ Division of Workers’ Compensation (DWC) adopted a drug formulary for the medical treatment of injured workers effective January 1, 2018.  Click here for more info.

    The links to resources and documents below offer information for providers relative to California Workers Compensation and MPN requirements.

    The following CA documents can be found on coventryprovider.com.

    • Economic Profiling Policy
    • California Client List
    • California Impairment Ratings Requirements
    • Guidelines for Medical Reporting
    • California MPN Provider Reference Manual

    To confirm which MPN(s) you participate in please visit our MPN Provider Information.

    Physicians treating in the California workers' compensation system are required to follow the evidence-based recommendations in the DWC medical treatment utilization schedule (MTUS). Click here to find the California Division of Workers Compensation Physician Education module.

    Connecticut

    The Connecticut MCP Provider Reference Manual can be found at coventryprovider.com.

    For more information about workers’ compensation in Connecticut, please visit: https://wcc.state.ct.us/

    Florida

    The Florida Provider Reference Manual and MCA Bulletin(s) can be found at coventryprovider.com.

    Georgia

    The Georgia Provider Reference Manual can be found at coventryprovider.com.

    Illinois

    The Illinois Provider Reference Manual and other documents can be found at coventryprovider.com.

    Kentucky

    The Kentucky Provider Reference Manual and other documents can be found at coventryprovider.com.

    Louisiana

    The Louisiana Client list can be found at coventryprovider.com.

    Massachusetts

    The Massachusetts Provider Reference Manual can be found at coventryprovider.com.

    For more information about workers’ compensation in Massachusetts, please visit: https://www.mass.gov/orgs/division-of-insurance

    Minnesota

    There are two separate legal entities under the Coventry umbrella that handle products and services in Minnesota, each with their own role and function.

    Coventry Workers’ Comp Services (Coventry)

    Coventry understands the challenges the current workers’ compensation environment and regulations present to our customers, and that developing a comprehensive solution to contain health care and disability costs can be a complex undertaking. Coventry provides employers, insurers and claims payors a variety national and state-specific medical management solutions that can help. These services include in-network and out-of-network medical claims review and re-pricing, access to specialized Preferred Provider Organizations ("PPOs"), early intervention and other cost management and related services. Coventry provides claims agent services and related activities; Coventry Rehabilitation Services, Inc. (“CRS”) provides Qualified Rehabilitation Consultant Services, as described in detail below.

    Coventry Rehabilitation Services, Inc. (“CRS”) 

    CRS is a registered Qualified Rehabilitation Consultant Firm (“QRC Firm”) in Minnesota that provides statutory vocational rehabilitation services performed by Qualified Rehabilitation Consultants (“QRCs”) as well as disability case management (“DCM”) services. All services provided by CRS and its QRCs in Minnesota comply with state mandated rules, statutes and regulations.

    A QRC is an objective participant, and conducts the rehabilitation consultation, writes the rehabilitation plan, including return to work goals and estimated costs for the claims adjuster, provides rehabilitation services, and guides the delivery of rehabilitation services by others. More specifically, the QRC may provide the following services: rehabilitation consultation, medical management, on-site job analysis, coordination of return to work (same or new employer), job modification, functional capacity evaluation, transferrable skills analysis, work evaluation, work hardening, job seeking skills training, job development, post placement follow-up, academic skills enhancement, vocational counseling, vocational testing, on the job training, labor market surveys, exploration of retraining, administrative duties (i.e., letter, reports or forms), attend legal proceedings, or incur other expenses. Examples of QRC prohibited activities include: authorizing medical services, auditing bills, promoting independent medical exams, among others.

    CRS may also provide DCM services for workers’ compensation claims when the qualifying criteria for QRC services have not been met on a claim but are provided pursuant to the parties’ agreement. DCM services may include: medical management, on-site job analysis, coordination of return to work (same employer), job modification, or other administrative duties (i.e., letters, reports or forms). Any individual performing DCM services on a claim that also holds a QRC registration should conform to the same standards of practice outlined above.

    Web Resources

    To learn more about workers’ compensation functions in Minnesota, please click these links below:

    Nebraska

    The Nebraska Provider Reference Manual can be found at coventryprovider.com.

    Nevada

    The Nevada Provider Reference Manual can be found at coventryprovider.com.

    As part of the recently-enacted Senate Bill 381 (SB381), the State of Nevada, Division of Industrial Relations (DIR) will be requiring all Workers' Compensation treating physicians, including Medical Doctors, Doctors of Osteopathy, and Chiropractors (providers), to complete a state application form and state specific credentialing process, in order to continue treating and evaluating workers’ compensation patients. The state has mandated the application process be completed.  Providers not completing the application will not be permitted to treat patients in the Nevada Workers’ Compensation system as of 7-1-2020.

    The highlights are as follows:

    Updated November 2020:

    Nevada began accepting applications in November of 2019 and will continue to accept applications on a rolling basis going forward.

    Applications should be submitted to the state’s e-mail address of medpanels@business.nv.gov as soon as possible, giving the state time to evaluate and approve your application.

    Coventry recommends that all applications be submitted as soon as possible, to allow adequate processing time by the state.

    The Nevada DIR provided a training seminar for workers' compensation providers to explain the provisions of SB381 and outlined the steps that providers need to take in order to be compliant.

    The slides of the presentation, along with full text of SB381, application instructions and application are available at the links provided below.

    Statute Full Text:https://www.leg.state.nv.us/NRS/NRS-616C.html

    SB381 Training Slides: http://dir.nv.gov/uploadedFiles/dirnvgov/content/WCS/TrainingDocs/SB%20381%20Training%20HCP%20AM%20Session.pdf

    Application, Instructions, and Key Information:
    http://dir.nv.gov/uploadedFiles/dirnvgov/content/WCS/WCS%20Tx%20Panel%20Application.%20Instructions%20and%20Key%20Information.pdf

    Please reach out to the State of Nevada Medical Unit for any questions regarding the application process:

    LAS VEGAS:

    Katherine Godwin, RN, Manager, Medical Unit
    Email kgodwin@business.nv.gov
    Phone: (702) 486-9080

    CARSON CITY:

    Sherry Crance, RN, Supervisor, Medical Unit (North)
    Email s.crance@business.nv.gov
    Phone: (775) 684-7275

     

    New Hampshire

    The New Hampsire Provider Reference Manual can be found at coventryprovider.com.

    For more information about workers’ compensation in New Hampshire, please visit: https://www.nh.gov/labor/index.htm

    New Jersey

    The New Jersey Provider Reference Manual can be found at coventryprovider.com.

    For more information about workers’ compensation in New Jersey, please visit: https://www.state.nj.us/dobi/index.html

    New York

    The New York Provider Reference Manual can be found at coventryprovider.com.

    Date October 2021

    The Chair has published a reminder that a number of requirements related to the Board's initiative to transition to the universal billing form, Form CMS-1500, become effective 10/01/2021, to coincide with the launch of OnBoard: Limited Release, the first phase of the Board's new business information system. Please see CMS-1500 Initiative Update (October 2021).

    Date: March 6, 202

    Adoption of Amendment and Proposed Amendment to 12 NYCRR 441.2 to Update the New York Workers' Compensation Drug Formulary

    The Board has permanently adopted amendments to 12 NYCRR 441.2 to update the New York Workers' Compensation Drug Formulary (NY WC Formulary). Please see Adoption of Amendment to 12 NYCRR 441.2 (June 2020).

    The Board has adopted on an emergency basis an amendment to 12 NYCRR 441.2 to update the New York Workers' Compensation Drug Formulary (NY WC Formulary). Please see Adoption of Amendment to 12 NYCRR 441.2 (April 2020).

    A full copy of the revised NY WC Formulary can be found at NY WC Formulary. Specific modifications can be found at NY WC Formulary Change Tracker.

    In response to Senate Bill 1505, the Workers’ Compensation Board (WCB) has adopted amendments to the regulations. These adopted amendments include a new regulation (12 NYCRR § 323.1) that describes the process for applying for WCB authorization to treat injured workers. Other adopted amendments integrate the new provider types into the Medical Treatment Guidelines variance request process (MG-2) and non-treatment guidelines requests for authorization (C-4 AUTH).

    Under this new law, the newly authorized provider types that will now be able to serve as an attending under the workers’ compensation system include duly licensed acupuncturists, nurse practitioners, occupational therapists, physical therapists, physician assistants, and licensed clinical social workers.

    All provider types (existing and newly authorized) are encouraged to view the following video for instructions on how to sign up for the WCB’s Medical Portal.

    For more information about Workers’ Compensation in NY, including an overview and FAQ on the expanded provider law, please visit the WCB website.

    Oklahoma

    The Oklahoma CWMP Provider Reference Manual can be found at coventryprovider.com.

    The online provider directory can be found here.

    The Oklahoma CWMP Dispute Instructions and Dispute Resolution Form can be found here.

    South Dakota

    The South Dakota Provider Reference Manual can be found at coventryprovider.com.

    Texas

    Texas Department of Insurance DWC Offers Health Care Providers and Staff Webinar Series - Click here to learn more!

    In the state of Texas, Coventry has developed Health Care Network (HCN) solutions for employers who subscribe to the workers' comp system and fee-for-service programs for employers who do not subscribe.

    HCN Solutions

    Coventry's Health Care Network (HCN) in Texas is designed to provide employers greater control of injury care, reduce lost-time costs and improve medical only-lost time ratios. HCNs are offered only to employers who subscribe to the workers' comp system.

    The TX HCN Provider Reference Manuals for Coventry, First Health, Texas Star Network, Zenith and Genex can be found at coventryprovider.com.

    Texas non-subscribers do not participate in the Texas Workers' Compensation system.  Non-subscribers must create their own occupational illness and injury plan and Coventry can support those employers by offering them a network to use as a part of their plan. These fee for service plans are not available to those who subscribe to an HCN plan regulated by the Texas Department of Insurance and/or Division of Workers' Comp.

    Please contact Coventry for more details on our HCN and/or non-subscriber offerings.

    Texas Closed Pharmacy Resources

    On July 1, 2018 the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) adopted changes to the Texas Closed Formulary for network and non-network claims. More information is available at: http://www.tdi.texas.gov/wc/rules/adopted/documents/ao1340418.pdf

    The Division of Workers’ Compensation has created a pharmacy resource web page providing information about the Texas closed pharmacy formulary, pharmacy fee guideline and other related pharmacy rules. The Texas closed pharmacy formulary is applicable to injuries occurring on or after September 1, 2011. The associated pre-authorization requirements will be applicable to certain legacy claims after September 1, 2013. https://www.tdi.texas.gov/wc/pharmacy/index.html

    Client Specific Information

    Helpful Links:

    Texas HCN Product Attachment (Exhibit 1) 

    Texas Certified Workers' Compensation Networks 

    Texas Department of Insurance 

    TDI Medical Fee Guidelines 

    Texas Department of Insurance Codes and Rules

    Official Disability Guidelines 

    International Academy of Independent Medical Evaluators 

    American College of Occupational and Environmental Medicine 

    Virginia

    The state of Virginia began a state fee schedule effective 1/1/2018. The most current fee schedule is effective January 1, 2020.

    See the state of Virginia for more details.

    West Virginia

    The West Virginia Provider Reference Manual can be found at coventryprovider.com.