WSI recently published an article about the Advanced Beneficiary Notice (ABN) process. After receiving several follow-up questions from providers about the article, WSI is providing further clarification.
The intent of the initial article was to inform a provider of WSI's requirement that, if a provider chooses to use an ABN form, the form is to be completed for each individual date the service will be provided. In the past, WSI accepted a single ABN for services provided for one or more dates of service.
A provider may choose to use the WSI ABN when recommending a service or medical device for a compensable injury but that WSI never covers, WSI may not cover, or WSI does not deem to be medically necessary. The following are circumstances and examples for which a provider may choose to complete an ABN form:
- Service is statutorily excluded from coverage, e.g. hot/cold packs, biofreeze, dry needling
- Service is statutorily limited in quantity, e.g. trigger point injections (maximum of 20 injections per claim)
- Service may not be covered by WSI, e.g. massage therapy performed by a massage therapist
- Service is deemed by WSI's Utilization Review department as not medically necessary to treat the work injury
In contrast, the following are circumstances and examples for which a provider does not need to use the ABN form:
- Routine service related to the treatment of a compensable work injury, e.g. office visit, therapy
- Treatment of a condition for which WSI has not determined liability or has denied liability
- Service generally considered unnecessary for the treatment of a compensable work injury, e.g. treatment for communicable diseases (common cold), seasonal disorders (allergies), pre-existing conditions (diabetes)