UR Clinical Criteria:

Effective 01/01/16, Tennessee adopted Official Disability Guidelines (ODG) in addition to their own Chronic Pain Guidelines.

ODG is a widely used workers’ compensation medical treatment, return-to-work (RTW), and drug formulary guideline. It is published by MCG Health and provides “unbiased, evidence-based guidelines” and analytical tools designed to “improve and benchmark return-to-work performance, facilitate quality care while limiting inappropriate utilization, assess claim risk for interventional triage, and set reserves based on industry data.” >> Learn More

Tennessee Chronic Pain Guidelines >> Learn More

UR Appeal Process:

If you have received a notification of an adverse determination, please review this information on how to file an appeal with the Tennessee Bureau of Workers’ Compensation. Additionally, here is the link to Form C-35A for your use.