Completing provider management plans
As a treating allied health provider, to request ongoing rehabilitation and treatment services for a worker, you must complete and submit a Provider management plan (PMP).
The PMP should be completed within the relevant allied health provider scope of practice.
What is the purpose of a PMP?
- A PMP allows the succinct exchange of relevant information for WorkCover (or the self-insurer) to determine if the requested treatment and rehabilitation services are necessary and reasonable.
- A PMP should outline the current clinical assessment of the work-related injury or illness – if this differs from the current medical information, we may need to seek clarification from the treating medical provider.
- A PMP should set out the specific nature of the requested treatment and rehabilitation services including item numbers, number of services, frequency of treatment and timeframes.
- A PMP should set out standardised and relevant outcome measures that track the worker’s overall recovery progress including any functional gains or improvements, e.g. capacity for work.
When should a PMP be submitted?
- A PMP should be submitted if treatment and rehabilitation services are requested beyond any of the following:
- pre-approved initial consultation
- pre-approved initial and subsequent consultations
- previously approved sessions in a PMP.
- These requirements are set out in the relevant Table of Costs. Please refer to Fees for more details.
How should a PMP be submitted?
- The PMP should be initiated and completed by the treating allied health provider.
- The PMP should be submitted to WorkCover via Provider Connect or uploaded via online services, or via the relevant self-insurer’s preferred method.
Can you charge for the completion of a PMP?
- No, a provider is not able to charge for the completion of the PMP.
- These requirements are set out in the relevant Table of Costs. Please refer to Fees for more details.
- You can indicate on the PMP if you wish to have WorkCover (or the self-insurer) contact you to discuss the PMP, the worker’s progress or any other specific claim matters. This will help reduce administration for all parties.
What happens after I submit the PMP?
- WorkCover (or the self-insurer) has the responsibility to determine whether the requested treatment and rehabilitation services are necessary and reasonable.
- WorkCover (or the self-insurer) will respond to the PMP once it has been submitted and reviewed.
- For WorkCover claims, the response will outline whether the PMP is approved, partially approved, or declined. This will occur within 5 business days. If the PMP is partially approved or declined, WorkCover will provide an explanation.
What else should be included on a PMP?
- Any identified biopsychosocial factors or other individual factors that may impact the worker’s recovery or return to work; and setting out any strategies or recommendations to address these factors e.g. other investigations, referrals or additional services.
- Any potential issues with current medications or other treatments that may need follow up with the treating medical provider or other providers.
What else should be considered when developing a PMP?
It is important that the worker is actively involved in the development of their own recovery goals, and that they understand their injury and the likely outcomes and timeframes of their recovery.
This should include early and collaborative goal setting with the worker to focus on common objectives to achieve recovery. Collaborative goal setting also empowers the worker to manage their own recovery.
Goals should focus on measurable improvements in:
- overall function and capacity
- activity at home
- return to work
- return to community and life.
The PMP should aim to incorporate these goals as relevant.
The PMP should also outline how the worker is being supported to self-manage as an essential pathway towards recovery. These might include a home-based exercise program, activity scheduling, pacing, establishing a sleep routine, pain management strategies and other self-management strategies.