HTML Preview Employees injured on job instructions page number 1.
Massachusetts
Institute of Technology
Workers’ Comp.
Main Office
77 Massachusetts Ave.
E19-215
Cambridge, MA 02139
Phone (617) 253-9496 • Fax (617) 253-1502
Located in Human Resources
Providers must call for the following types
of medical services that require Utilization
Review (UR) approval. For approval, call
Quality Review Associates, Inc.
Phone: 1-800-383-4845
Fax: 781-246-3167, M–F, 9 a.m.–5 p.m.
1. All non-emergency hospitalizations,
outpatient surgery, and transfers between
facilities
2. Psychiatric or psychological therapy or
testing
3. All external and implantable bone growth
stimulators
4. All chemonucleolysis, facet or trigger
point injections
5. Repeat baseline diagnostic studies and
laboratory testing
6. Video fluoroscopy
7. Radiation or chemotherapy
8. Biofeedback therapy
9. Physical or occupational therapy*
10. Work hardening
11. Work conditioning
12. All durable medical equipment
13. Nursing home, convalescent, residential
and all home health care services and
treatment
14. Pain clinics, chemical dependency clinics
or weight loss
15. All non-emergency dental services,
including reconstructive dental care
16. Magnetic Resonance Imaging (MRI)
17. Chiropractic treatment*
18. Acupuncture treatment*
Administered by Cannon Cochran Management
Services, Inc. CCMSI
Utilization Review Agent:
Quality Review Associates, Inc.
c/o CCMSI
100 Quannapowitt Parkway, Suite 201
Wakefield, MA 01880
All questions and work injury-related
medical bills should be directed to your
local claims office. See center of this
handout for information.
*
After initial evaluation, approval is required for additional
treatment by provider.
PLF-3224(R-5)_M.indd
Lincoln Laboratory
Employees’
Workers’ Comp. Ofce
244 Wood Street
B-325
Lexington, MA 02420
Phone (781) 981-2382 • Fax (781) 981-0145
Located in the Lincoln Environmental,
Health and Safety Ofce
MIT Broad Institute
320 Charles Street
NE125-108A
Cambridge, MA 02141-2023
Phone (617) 452-4818 • Fax (617) 258-0903
Workers’ Compensation
Instructions
to Employees
Injured on the Job
Prescription Medications
If you are prescribed medication for your work injury,
please contact your claims ofce before lling the
prescription. Progressive Medical is used for lling pre-
scriptions. Call them at 1-888-908-6337.
Massachusetts
Institute of Technology
* MIT is self-insured.