Telephonic Case Management
Our telephonic case-management service brings to bear a team of expert nurses to help workers achieve the most efficient and effective recovery and return to work. At any point in the life of a claim — from the earliest report until well after the claim is mature — a nurse can help workers achieve the best outcomes and, in turn, reduce time away from work and medical spending.
Field Case Management
When a case manager’s ability to remotely oversee a case is stretched, our field case managers are available to direct the best possible outcomes for the most complex cases. Even difficult, high-dollar cases can be made less severe through timely, well-orchestrated coordination of care.
Monitoring the clinical appropriateness of an injured worker’s treatment is key not only to a speedy and successful recovery but also to holding down medical spending. Our team of nurses and physicians stands ready to evaluate your claims for the best possible treatments. Whether it is before, during or after a course of treatment, our UR team can help ensure the most appropriate and standards-compliant procedures are reimbursed.
How It Works
- Our medical director oversees a team that helps guide clinically appropriate care and maintain compliance with a range of jurisdictional requirements.
- The UR process is draws upon Official Disability Guidelines and other widely respected protocols for driving the best clinical decision-making.
Independent Medical Exam
Our independent medical exams are foundational to ensuring injured workers are properly diagnosed and treated. This not only protects the patient from unnecessary or perhaps harmful care, it also saves unneeded spending and limits liability in cases where the cause and effect of an injured or ill worker's case are in dispute.
We provide a comprehensive peer-review program that matches like-to-like providers for jurisdictions in which doing so is required.
One important service is a review of radiology readings to ensure a proper diagnosis of an injured worker's condition. This key service illustrates the level of depth of our approach to ensuring an injured or ill worker is properly diagnosed to allow for the most appropriate and effective treatments. A team of skilled radiologists is on hand to offer an oftentimes critical second opinion for complex cases. This helps avoid unnecessary and perhaps risky treatments and more timely attention to the most pressing issues that injured or ill workers face.
An audit of a hospital or similar medical care facility is an important part of ensuring workers can obtain the best-quality care that will speed their recovery. We document and evaluate a range of critical statistics about a facility to hold providers accountable for furnishing injured or ill workers with care based on the highest standards.
Medicare Set Aside
Our Medicare Set Aside (MSA) team guides you though this complex process and helps apportion the right level of funding for future care. We take seriously our commitment to offering the most accurate forecast possible for the future cost of medical treatments for an injured worker. This is important because Medicare must not pay for treatments that come from an event such as a workplace injury. Rest assured our team has deep experience in how to complete MSA evaluations and makes solid recommendations.