Practice Information

Administrative Excellence

Please attach documentation or describe how your practice meets the following standards:

• Completes all reports and required documentation timely and accurately.

• Maintains written procedures for managing workers’ compensation cases.

• Tracks authorizations, scheduling, and case progress systematically.

• Maintains policies for compliance, ethics, and privacy.

• Monitors administrative turnaround times and quality of deliverables.

Communication & Coordination

Please attach documentation or describe how your practice meets the following standards:

• Maintains a dedicated workers’ compensation coordinator or point of contact.

• Provides consistent communication updates to employers, carriers, and case managers.

• Responds to requests (calls, emails, faxes, portals) within a defined timeframe.

• Uses secure communication methods or portals when available.

• Maintains policies for response times and communication standards.

Clinical Quality & Patient Care

Please attach documentation or describe how your practice meets the following standards:

• Provides prompt scheduling for initial and follow-up appointments.

• Prioritizes early diagnosis and conservative care when appropriate.

• Provides detailed, task-based work restrictions (not generic “light duty”).

• Monitors patient progress and return-to-work outcomes.

• Follows standardized treatment pathways or evidence-based guidelines.

Compliance & Ethical Practice

Please describe how your practice meets the following standards:

• Adheres to all applicable state and federal workers’ compensation regulations.

• Maintains full transparency in billing, coding, and documentation.

• Provides ongoing compliance education and training for physicians and administrative staff.

• Ensures secure handling, transmission, and storage of all protected health information (PHI).

• Maintains clear written policies for ethics, privacy, and professional conduct.

• Regularly reviews and updates internal procedures to align with industry standards and legal requirements.

Ancillary and Integrated Services

Please attach documentation or describe how your practice meets the following standards:

• Maintains clear policies governing all ancillary and in-office services, including diagnostic testing, DME, dispensing, physical therapy, occupational therapy, and other specialty support services.

• Ensures all ancillary services are clinically appropriate, authorized when required, and performed in compliance with state and national workers’ compensation regulations.

• Follows established authorization protocols before performing or billing for ancillary services, including imaging, diagnostics, and therapy.

• Demonstrates transparency in pricing, billing, and utilization for all ancillary and in-office services.

• Uses credentialed or contracted providers and vendors for services such as DME, imaging, or therapy when performed offsite.

• Monitors utilization to prevent unnecessary or excessive procedures, dispensing, or ancillary services.

• Ensures all services, whether in-office or referred, support timely recovery and return-to-work outcomes.

• Maintains written policies and oversight mechanisms to ensure consistent adherence to clinical and administrative standards.

Outcome-Based Performance Metrics

Demonstrating measurable outcomes in recovery and return-to-work performance is a core requirement for achieving the OM Center of Excellence (COE) Designation.

Each practice must provide verifiable data and submit a minimum of five (5) de-identified workers’ compensation case studies that reflect clinical quality, coordination, and outcomes that support injured workers in safely returning to their pre-injury baseline.

Practices are expected to track and report objective data demonstrating their effectiveness in facilitating timely recovery, functional improvement, and sustained return to work.Please complete the table below using data from the most recent twelve (12) months.

Case Study Submission Requirement

Each practice must submit five (5) de-identified case studies that demonstrate the practice’s success in achieving timely recovery, safe return to work, and restoration of pre-injury function.These case studies should represent actual workers’ compensation patients and highlight collaboration, clinical quality, and communication that led to positive outcomes.

Each case study should include:

1. Type of Injury / Condition: (e.g., orthopedic, spine, occupational, etc.)

2. Initial Evaluation: Date of injury and date of first appointment.

3. Treatment Approach: Summary of the care plan and key interventions used to promote recovery.

4. Coordination of Care: Description of communication with adjusters, employers, and case managers to ensure continuity of care and work accommodation when needed.

5. Outcome Summary:

   • Return-to-work timeline (full or modified duty)

   • Functional recovery level compared to pre-injury baseline

   • Confirmation of Maximum Medical Improvement (MMI)

   • Case duration (injury to resolution)

6. Recovery Highlights: Administrative or clinical steps that helped accelerate recovery, minimize lost time, and improve functional outcomes.

Supporting Materials

To complete your OM Center of Excellence (COE) Designation: application, please attach all relevant materials that verify and support your responses.Supporting documents provide evidence of your practice’s established processes, compliance, and quality of care for injured workers.

Recommended Supporting Materials

• Workers’ compensation policies and procedures manual

• Compliance and ethics policy summary

• Sample documentation or report templates (all patient information must be removed)

• Proof of staff training or continuing education on workers’ compensation standards

• Internal communication workflow or process outline

• Facility license and physician credentials

• Any applicable inspection, certification, or audit reports

• Data summaries or internal dashboards reflecting performance metrics

Confidentiality Notice: All submitted materials are confidential and will be used solely for the purpose of evaluation by the OM administrative review team and the Independent COE Oversight Committee.

Attestation

I hereby attest that all information and documentation submitted as part of this application are true, accurate, and complete to the best of my knowledge.I understand that submission of this application does not guarantee designation and that all determinations are made exclusively by the Independent COE Oversight Committee based on established OM COE criteria. I further acknowledge that OM reserves the right to verify all information and request additional documentation as part of the evaluation and certification process.

Evaluation and Designation Process

All applications will undergo a structured review to ensure accuracy, compliance, and alignment with COE standards. Evaluation will include:

1. Administrative Review: Initial verification for completeness and eligibility.

2. Committee Evaluation: Independent review by the COE Oversight Committee, including physicians, employers, adjusters, case managers, and industry experts.

3. Final Determination: Scoring based on verified performance, compliance, and measurable outcomes.

4. Designation Term: Practices that meet all requirements will be awarded the OM Center of Excellence (COE) Designation, valid for two (2) years.

Recognition and Renewal

Recognition

Practices that achieve the OM Center of Excellence (COE) Designation will receive formal recognition for their demonstrated excellence in the care and management of injured workers. Recognition includes:

• Authorization to display the official OM COE Seal on the practice’s website, professional materials, and communications.

• A digital Certificate of Designation for official and internal use.

• National acknowledgment from OM as a Center of Excellence–Designated practice.

• Eligibility to be featured in OM educational or industry publications highlighting best practices in workers’ compensation care.

• Optional inclusion in the OM National Directory of WorkCompReady™ and COE-Designated Providers (available to practices who choose to participate in OM’s directory services).

Note:The OM Center of Excellence (COE) Designation is a professional certification of excellence and is separate from OM’s marketing programs.Practices do not need to be OM clients to apply for or earn the COE Designation.The WorkCompReady™ Certification is a distinct training and certification program available exclusively to physicians who are part of the OM Panel.

For more information regarding the WorkCompReady™ Certification, please contact info@ommktg.com.

Designation Term and Renewal

The OM Center of Excellence (COE) Designation is valid for a period of two (2) years from the date of approval. To maintain the designation, practices must demonstrate continued adherence to COE standards, compliance requirements, and quality outcomes.

Renewal Process:

• Practices will be notified 90 days before their designation expiration date.

• Renewal requires submission of an updated application, verification of continued compliance, and current outcome data.

• Renewal reviews will focus on measurable improvement, ongoing education, and sustained excellence in care and communication.

The Independent COE Oversight Committee reserves the right to re-evaluate or revoke the designation if a practice no longer meets the required standards or fails to uphold the integrity of the COE program.

Cost and Program Independence

The OM Center of Excellence (COE) Designation is a national designation that recognizes medical practices demonstrating the highest standards in the care and management of injured workers. This designation is a professional recognition of excellence—not a certification, membership, or marketing program. It operates independently from all OM Marketing services and business affiliations.

The COE Designation is based solely on verified performance, compliance, and measurable outcomes in workers’ compensation care. It does not include or imply any marketing, promotional, or referral activity.

• The COE Designation is open to all qualified medical practices nationwide, regardless of affiliation with OM.

• OM Marketing services are separate and available only to active OM clients under a different agreement.

• Earning the COE Designation does not create, imply, or extend a marketing or contractual relationship with OM.

• The WorkCompReady™ Certification is a separate, educational certification program available exclusively to physicians who are part of the OM Panel.

Fee Structure

All fees support the administrative review, committee evaluation, and verification process.Fees are non-refundable once review begins.

Application Fee

Comprehensive review and evaluation by the Independent Oversight Committee.

$2,500

Reapplication Fee

Applies to practices reapplying after a conditional or deferred review.

$1,250

Renewal Fee

Two-year re-evaluation and verification of continued compliance and outcomes.

$1,500

Expedited Review (Optional)

Accelerated review timeline available upon approval.

$3,500

Recognition and Benefits

Practices that earn the OM Center of Excellence (COE) Designation are formally recognized for their proven commitment to quality, accountability, and excellence in the care and recovery of injured workers. This national designation represents measurable performance, administrative integrity, and strong clinical outcomes within the workers’ compensation system.

Recognition includes:

• Official COE Designation Letter and Seal – Practices receive a formal digital certificate and seal for professional display on their website, materials, and office communications.

• Public Recognition – Designated practices are acknowledged as national leaders in the care of injured workers.

• Directory Listing Option – Practices may elect to be featured in the OM National Directory as a COE Designated Provider. Listing is optional and available separately through OM.

• Use of COE Seal – Practices may use the official OM COE Seal in professional communications, presentations, and documentation.

• Verification of Excellence – All designated practices are included in OM’s national registry of verified COE Designees for compliance and reference purposes.

The COE Designation is a formal national recognition based on verified outcomes, performance, and adherence to the highest standards in workers’ compensation care. It is not a marketing program, and participation in OM marketing or promotional services remains exclusive to OM clients under separate agreements.

Final Acknowledgment

By submitting this application, the practice affirms that all information provided is accurate, complete, and reflective of its actual operations and outcomes in the care and management of injured workers. All materials submitted will remain confidential and used exclusively for evaluation by the Independent OM Center of Excellence Oversight Committee. Designation decisions are based solely on verified documentation, compliance with program standards, and measurable outcomes.

The OM Center of Excellence (COE) Designation is a national recognition of excellence, independent from all OM marketing programs and affiliations.Earning this designation signifies that a practice upholds the highest standards of patient care, administrative integrity, and performance in workers’ compensation healthcare.

Applicant Attestation

I hereby attest that all information provided in this application and any accompanying documentation is true, accurate, and complete to the best of my knowledge.I understand that submission of this application does not guarantee designation and that all evaluations and final decisions are made by the Independent OM Center of Excellence Oversight Committee. I acknowledge that the OM Center of Excellence (COE) Designation is a national recognition of excellence in the care of injured workers, independent from OM’s marketing programs or affiliations.

Submission Confirmation

Once your completed application and all supporting materials have been submitted through the OM website, you will receive an acknowledgment confirming receipt.Your application will then proceed to administrative review before being forwarded to the Independent OM Center of Excellence Oversight Committee for evaluation. If additional information is required, your designated contact will be notified.Please allow up to 6–8 weeks for full review and notification of your application status.

For questions or assistance, contact the OM COE Program Team at info@ommktg.com.