On July 1, 2013, the Work Loss Data Institute’s (WLDI) Official Disability Guidelines (ODG); went into effect in New Mexico under Parts 4 and 7 of the WCA Rules for the treatment of workers’ compensation injuries. All medical services rendered for recommended treatment contained in the most recent edition of Official Disability Guidelines (ODG) are presumed reasonable and necessary.
ODG FAQs (Click on the question below to expand the section to view the answer)
Also, part of the Treatment Guidelines is the UR Advisor and the Drug Formulary/NDC Advisor. The UR Advisor allows users to plug in the diagnosis and a procedure (by code or key words) to get the ODG Approval Status, along with other data like median number of visits or average costs. The Drug Formulary is where all of the medications found in ODG are indexed, and the NDC Advisor is a look-up tool for easy access to specific drugs by name or NDC. Information provided includes strength, trade name, ODG status (Y or N), as well as links to the Procedure Summaries where more information is available on adverse effects, dosage, and links to the medical evidence.
There is an Editorial Advisory Board whose members are health care professionals that develop, review and approve changes to the guidelines. There are about 100 members, most of whom are volunteers and some who are editorial writers who are compensated.
Doctors are not bound to the guidelines. The guidelines create a presumption that treatments are reasonable and necessary. WCA rules say that treatment that is reasonable and necessary should be paid. That doesn’t mean the treatment is automatically approved.