Wyoming: Injured Workers FAQ

Following are answers to some of the more commonly asked questions. Should you have additional questions, please feel free to contact your workers’ compensation insurance adjuster, Majoris Health Systems at (800) 525-0394, or your Majoris claim representative directly.

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What is Majoris Health Systems?

Majoris Health Systems works with Wyoming employers who do not use the Wyoming State Fund for their workers’ compensation insurance. Majoris is responsible for providing a medical provider network developed specifically for the treatment of work injuries. We partner with medical providers who have met stringent credentialing standards and have agreed to follow best practices for work-related injuries to ensure employees receive best-in-class care.

Is Majoris a Workers’ Compensation insurance company?

No, Majoris is not an insurance company. In Wyoming, Majoris works with employers who have an alternative program to the Wyoming State Fund workers’ compensation coverage. Our role is to support the medical care you receive through our network of medical providers.

Am I required to see one of the Majoris providers if I am injured on the job and need medical care?

Most likely yes, if there are available network providers in the specialty required to treat your work injury. Your employer will provide notification that you are subject to treating within the Majoris provider network and if you are required to change providers.

What if I am currently receiving care from a non-Majoris provider for a work-related injury or illness?

It depends on the nature of your injury, the available Majoris network options and your employer’s policy. Your employer or their representative will notify you of your specific requirements.

What do I do if there is a medical emergency and I’m not able to see an Majoris provider?

In true emergency cases, Majoris, your employer and your insurer believe the first priority is to have your medical emergency taken care of.  An emergency is defined as a medical condition that creates the risk of death, serious disability, or serious medical consequences if treatment is not rendered immediately.

If you are far away from, or otherwise unable to receive care from, a Majoris provider in an emergency, you should seek care from the nearest appropriate medical facility.  After you are out of immediate danger, all follow-up care will be provided within the network.  If emergency care is needed and an appropriate Majoris facility is available, care should be sought from the Majoris member facility if possible.

If you are in need of emergency care and unsure of where to go, seek medical care from the closest available medical facility.  Emergency care should not be used as a substitute for routine, ongoing medical care from an attending physician.

What can I do if I disagree with an action taken by Majoris or one of its network providers?

Majoris wants to make sure you receive timely, effective, and convenient medical services for your work-related injury.  However, should a dispute arise concerning your care within the MCO, you may request review through Majoris’ Wyoming Dispute Resolution Process.

Majoris offers a unique medical review process that ensures high-quality care from enrollment to resolution. We proactively monitor key events, maintain regular communication with claims adjusters and managers, and leverage our physician reviewers to handle complex cases. Our approach includes:

  • Proactive File Review Medical Management
  • Medical Treatment Reviews by Board-Certified Physicians
  • Evidence-Based, Peer-Reviewed Guidelines
  • Physician-to-Physician Treatment Collaboration

Additionally, we address common concerns within the workers’ compensation system with innovative programs like our prospective opioid management and sprain/strain programs. This ensures treatment plans and physical restrictions are informed by objective findings, are focused on the work injury, and incorporate a progressive return to work and life activities. The result is higher quality care and significant long-term savings.

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Better networks create better results.

Majoris is selective in the providers we partner with, seeking those who understand the unique demands of treating workers’ compensation patients and who meet high credentialing standards. Our provider relations staff keeps in close contact with our providers to support strong relationships, providing training on workers’ compensation best practices and outreach on individual cases experiencing administrative stall-outs.

When there are questions about treatment, providers can expect to speak with a board-certified physician with a background in treating injured workers. Our outreach is centered on collaboration, with the goal of finding the right treatment plan for each patient’s unique needs.

Credentialing

Credentialing goes beyond confirmation of licensure and malpractice history – we look at past treatment records to ensure there is evidence of sound medical reasoning, reliance on objective medical findings and integration of daily activities and work into the overall rehabilitation plan.

Best Practice Standards

To support their responsibilities as a provider of care to injured workers, Majoris developed a series of guidelines, protocols and techniques to facilitate efficient delivery of care within the workers’ compensation framework. This includes support of other stakeholders’ responsibilities.

Our provider manual offers a road map of best practice, streamlining the flow of required information to reduce effort and administrative burden for all. Our treatment guidelines are derived from evidence-based medicine and specific to the workers’ compensation patient population when the data is available.

All network providers have committed to following these best practices, and our provider relations team provides hands-on support when needed to ensure information is received and timelines are met.

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We utilize sophisticated IT solutions, featuring customized programs and advanced data interfaces. The result is seamless collaboration with all stakeholders and high data integrity. Our cutting-edge technology streamlines operations, enhances communication, and drives effective collaboration.

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