Medical Review Team (MRT)
If an individual claims incapacity, but
does not fit one of the Field Determination
reasons, complete an MRT Referral.
The Medical Review Team will examine
medical records, and determine if an
individual meets incapacity criteria.
Determine technical/financial eligibility
before sending the referral to MRT.
Allow 10 days to return the information
for technical and financial eligibility.
If technical and financial eligibility is
met, send the referral to MRT.
MRT Helpful Tips
The following guidelines could help reduce
the time it takes for an MRT determination.
Annotate “Status” correctly on the PA-601T
Complete PA-601T entirely, do not skip items
Include full names, addresses and phone
numbers for all providers
Include dates of service for all providers
Dates of Treatment
MRT only requests current medical records.
If the last visit to a provider or hospital was
over a year ago, it is usually not requested.
For re-determinations, MRT only requests
records from visits since the last decision.
If dates are unknown, try to pin down a
time period such as: last month, last 6
months, over a year ago, etc. This is more
helpful than “don’t know” or blank.
Release of Patient Records
Complete MRT-15 correctly, in its entirety
The patient signs the MRT-15 release form.
We need original signatures on each MRT-15.
Do not make copies!
The worker can witness the signature, only if
signed in their presence.
Obtain one MRT-15 for each provider listed
on the PA-601T, and a few extra, just in case.
If MRT’s decision states that incapacity is for a
limited time, a re-determination may be
needed if the individual is still incapacitated.
Complete a PA-601R for Re-determinations.
Interview the client and list only providers
seen since the PA-601T was completed.
Send old medical records and the last MRT
decision (PA-6) along with the PA-601R.
Obtain new MRT-15s for current doctors listed.
MS 2389 outlines the procedures
to be used if MRT schedules a
This may be needed if the
individual has no previous
A typed PA-601T would be ideal, but we
realize this is not feasible in most instances.
If you are hand-writing a PA-601T, please
try to write as legibly as possible.