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Majoris Health Systems MCO Provider Directory

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Majoris Health Systems MCO Provider Directory Majoris Health Systems, Inc. Employee Information and Medical Provider and Facilities DIRECTORY May 2021 R-2031 Majoris Health Systems, Inc. ________________________________________________________________________________________________________ SAIF Corporation, has contracted with Majoris Am I required to see one of the Majoris doctors Health Systems, Inc., a state-certified managed if I am injured on the job and need medical care organization (MCO) to provide services to care? employees injured on the job. In most cases, yes. Once your claim is “enrolled” We understand that dealing with an injury can with Majoris Health Systems, (which means you sometimes be stressful and confusing. We have been given written notice of your therefore recommend that you become familiar requirement to treat within the MCO) you will be with the Majoris procedures before you may need required to treat with an MCO provider unless to seek care for a work-related injury or illness. one of the circumstances explained below applies. Following are answers to some of the more commonly-asked questions concerning our The situations in which you may receive managed care program. Should you have compensable care from a non-Majoris provider additional questions, please feel free to contact after your claim is enrolled are as follows: SAIF Corporation at 800.285.8525, or Majoris 1. You have a private physician, Health Systems directly at 800.525.0394. chiropractic physician, or nurse practitioner who qualifies as a primary What is Majoris Health Systems? care physician, chiropractic physician Majoris is a state-certified managed care or authorized nurse practitioner. organization that contracts with physicians, Your family physician, chiropractic physician, hospitals, and other health care providers to or authorized nurse practitioner may qualify to provide medical services to covered employees treat you under the managed care with work-related injuries or illnesses. These arrangement, even if s/he is not on the Majoris providers are carefully selected and trained in the list of contracted providers. To qualify: treatment of work-related conditions. Majoris, and the health care providers want to make sure . Your provider must be a medical doctor that timely, effective, and convenient medical (M.D.) or osteopath (D.O.), chiropractic services are available for our covered workers. physician (D.C.) or authorized nurse Majoris will also be working closely with your practitioner. doctor and SAIF Corporation to help you return to . Your doctor must be a family practitioner, gainful employment as soon as possible after an general practitioner, internal medicine on-the-job injury or illness. specialist, chiropractor, or authorized nurse practitioner. Is Majoris a workers’ compensation . You must have a history of being treated insurance company? by that doctor or authorized nurse practitioner, or have the doctor or No. Majoris contracts with SAIF Corporation, a authorized nurse practitioner as a workers’ compensation insurance company. designated primary care provider under Majoris monitors medical care that is provided to your group health plan. ensure that it is appropriate and necessary, and . The doctor or authorized nurse practitioner it meets specific quality standards. must agree to abide by all terms and Majoris does not make decisions on acceptance conditions of Majoris Health Systems, and or denial of claims, payment of time loss or must refer you to a Majoris provider for medical benefits, or any other workers’ any additional care you may need. compensation benefits. Decisions concerning If your authorized nurse practitioner is qualified these and all other claims issues remain the to provide your care, s/he will be allowed to responsibility of SAIF Corporation. provide medical treatment and authorize time loss for 180 days from the date of the first nurse practitioner visit on the initial claim. R2031 Majoris Health Systems, Inc. Directory Page 2 May 2021 2. There are fewer than three MCO review, please submit your request in writing to providers available in a given category the address listed within 30 days of the date of in Majoris’ geographical service area. the action. Failure to request review in writing within 30 days precludes further appeal. You may be allowed to seek treatment from a non-Majoris provider if there are fewer than What if I need help finding or scheduling three Majoris providers in the following an appointment with an MCO provider? categories: If you would like help in scheduling an . Acupuncturist (LAC) appointment, or if you have contacted several . Optometrist (OD) panel providers and were not able to schedule a . Chiropractor (DC) timely appointment, please contact Majoris for assistance at 800.525.0394. Dentist (DMD or DDS) . Naturopath (ND) What do I do if there is a medical emergency . Osteopath ((DO) and I’m not able to see a Majoris provider? . Physician (MD) In true emergency cases, Majoris, your employer . Podiatrist (DPM) and SAIF Corporation believe the first priority is . Physical therapist (PT) to take care of the medical emergency at an appropriate medical facility. An emergency is . Psychologist defined as a medical condition that if treatment is . Authorized nurse practitioner (ANP) not rendered immediately, creates the risk of All out-of-panel treatment will be subject to death, serious disability or serious medical Majoris’ utilization and treatment standards. consequences. 3. You reside outside Majoris’ If your claim is subject to the MCO, and you are geographical service area. far away from or otherwise unable to receive care from a Majoris provider in an emergency, you If you reside outside Majoris’ geographical should seek care from the nearest appropriate service area you may select a non-MCO medical facility. After you are out of immediate provider if they practice closer to your danger, all follow-up care must be provided residence than an MCO provider of the same within the MCO. If emergency care is needed and category and if they agree to the terms and an appropriate Majoris facility is available, care conditions of the MCO. should be sought from the Majoris member If you think you qualify for any of the above facility if possible. exceptions and would like consideration for If you are in need of emergency care and unsure out-of-panel treatment, please contact your of where to go, seek medical care from the adjuster to begin the review process. closest available medical facility. However, Should you receive care from a provider who emergency care should not be used as a does not meet the above criteria for out-of- substitute for routine, ongoing medical care from panel treatment, SAIF Corporation will not be an attending physician. required to pay for medical services. What can I do if I disagree with an action taken by Majoris or its member physicians? What if I live a long distance from Majoris’ service area? SAIF Corporation and Majoris both want to make sure you receive timely, effective and convenient If you live more than one hundred miles from medical services for your work-related injury. Majoris’ geographic service area, you will not be However, should a dispute arise concerning your subject to the MCO arrangement. care within the MCO, you may request review through Majoris’ Internal Dispute Resolution What if I am currently receiving care from a Process. non-MCO provider for a work-related injury or illness at the time I am enrolled into the Such request must be made in writing within 30 MCO program? days of the action giving rise to the dispute. You should state the specific issue for which you are You will be required to begin treating with an requesting review, and include any information MCO provider, with the exceptions noted above. you think we should consider in our review. Howevery, if you are not yet medically stationary Address your requests to “Administrator, and think that a change of physicians would be Majoris Health Systems, P.O. Box 1728, medically detrimental to you, you may request Lake Oswego, OR 97035.” If you appeal review of your situation by the MCO. To request R2031 Majoris Health Systems, Inc. Directory Page 3 May 2021 timely, we will review the disputed decision and notify you of our decision within 60 days of your request. Thereafter, if you continue to disagree with our decision, you may appeal to the Director of the Department of Consumer and Business Services for further review. Please note that failure to submit a request for review in writing to Majoris Health Systems within 30 days of the action giving rise to the dispute means you lose your right of further appeal to the Director of DCBS. Remember: Injured workers should remember to tell the Majoris MCO doctor that they were injured on the job (when and how) and the employer’s name. They will be asked to sign a form (Form 827) so the doctor can release information concerning the injury to SAIF. Injured workers and employers should also complete the Employer’s Report of Injury (Form 801). It can be submitted online (through Business Online) or downloaded and emailed ([email protected]), faxed to 800.475.7785, or mailed to “SAIF Corporation 400 High St SE, Salem OR 97312-1000” within five days. For more information, contact: Majoris Health Systems, Inc. P.O. Box 1728 Lake Oswego, OR 97035 P: 800.525.0394 F: 503.639.8521 www.majorishealthsystems.com R2031 Majoris Health Systems, Inc. Directory Page 4 May 2021 MAJORIS HEALTH SYSTEMS LISTING OF FACILITIES HOSPITALS Asante Ashland Community Lower Umpqua Hospital
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