New Forms Required When Seeking Approval for Lumbar Fusion Surgery

March 2016

Effective April 1, 2016, Workforce Safety & Insurance (WSI) will require submission of the newly developed Pain Questionnaire and Surgery Expectation Questionnaire forms when requesting a prior authorization request for a lumbar fusion surgery.

WSI previously published a treatment guideline to assist in the utilization review and claim management process for lumbar fusion surgery (see Medical Treatment Guidelines Available Online (August 2015)). The new forms enhance the review process for lumbar fusion surgery.

A provider may access these forms on our website under the Medical Treatment Guidelines section. It is the responsibility of the provider to supply the patient with the forms, assist the patient with completion of the forms, and submit the completed forms along with the Utilization Review Request (UR-C) form.

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