Case Record means the complete health care record that is maintained by the insurer and pertains to an employee's injury or illness. Diagnostic Procedure means a service that aids in determining the nature and cause of a disease or injury. Diagnostically Related Groups means codes that refer to certain classes of diagnoses for prospective payment purposes by which health care providers are paid a pre-set amount for treatment of a particular medical ailment. Dispute means a disagreement between an insurer, an employee, a provider or any other party concerning the application of M.G.L. c. 152. Emergent Admission means placement of an employee in a facility for the care of a work-related medical condition of an unforeseen or rapidly progressing nature.
Facility means any location intended as a site for medical treatment.
Guidelines mean optimal strategies for patient management around which practice patterns should converge. Health Care Services means treatment services rendered to an injured employee by a provider pursuant to M.G.L. c. 152. Inpatient Care means that care which requires an employee to stay overnight in a facility. Medical Condition means the physical or mental health status of an injured employee as determined by the provider administering health care services. Medical Release means a signed release by the injured employee authorizing release of all relevant medical information regarding the injury.