Authorization – The following guidelines apply to all DOT referrals made by MYgroup.
1. Client is approved for two sessions only (assessment and follow-up).
2. You must call MYgroup at 866-850-2175 to discuss appropriate clinical recommendations. Do not contact the client’s employer under any circumstances.
3. You must make a recommendation for education and/or treatment for the client. Under DOT guidelines, referring to yourself or any professional in your practice is not permitted. You may not have any financial interest in the person or place to which you refer.
4. When the employee has completed or made significant progress in the treatment process, you may schedule a follow-up evaluation for successful compliance and the follow-up testing plan (a minimum of six within the first 12 months). Additional random testing can be recommended for the next four years.
5. It will be the responsibility of the client company to schedule the return to work alcohol and drug screens.
* Please note that MYgroup does not reimburse for late cancellations or “no shows.
Authorization for Release of Client Records
– Completed and signed by client and sent to MYgroup
SAP-DOT Intial Assessment Letter
– After the initial assessment, fax the customized Initial Assessment Letter (based on the sample provided) to the designated employer representative and to MYgroup. This letter must be on letterhead.)
SAP-DOT Follow-Up Evaluation Letter
– After the follow-up evaluation, fax the customized Follow-Up Evaluation Letter (based on the sample provided) which includes the follow-up testing plan to the designated employer representative and the MYgroup case manager.
Mail all information to MYgroup, 5925 Carnegie Blvd., Suite 350, Charlotte, NC 28209. Or, fax all information to 704-529-5917. Attn: Provider Relations Department.