We can establish you with a 'workers comp' managed care program that focuses on providing
benefits for covered employees having occupational disabilities, while containing
costs. We use a network of preferred physicians and other health care providers
to provide quality medical care and products at affordable prices.
The following is more detail on these programs:
Prompt reporting - important for quality service while containing workers compensation costs
The most important aspect of containing costs on workers compensation claims
and providing quality service to our customers and injured employees is prompt
reporting of the loss. It enables us to investigate and pay benefits promptly
to avoid litigation, manage disabilities more effectively and apply our cost-containment
programs as soon as possible.
On-site case management (OCM)
Medical disability specialists help field claims staff evaluate, manage and
make recommendations regarding the medical and/or vocational aspect of
workers compensation, personal injury protection and bodily injury files.
The philosophy of case management is based on a cooperative approach involving
Harleysville, the injured worker, the worker’s family, the medical
provider and the employer.
Physician panels
Our provider network unit (PNU) is dedicated to providing our workers comp
policyholders with physician panels to treat their employees who have job-related
injuries. Customer participation ensures quality healthcare and controls
costs. We are committed to enabling the highest possible access to CorVel’s
national network of preferred providers.
Preferred provider network
The preferred provider network (PPN) provides the following services to our
customers:
Access to a PPO network
Creation of panel postings
Repricing of provider bills
Monthly management reports
Ability to nominate to the PPN
The ultimate goal of the PPN is to assure that injured workers are provided
with quality health care, which in turn will decrease indemnity dollars through
the channeling of treatment into the PPN.
Medical cost projections
Medical cost projections (MCP) assist the claims staff in setting, adjusting
and anticipating realistic reserving needs for any file in which medical needs
are catastrophic or serious in nature. They are an estimate of the medical
care and associated costs that a claimant might expect to undergo for the
duration of the disability. MCPs pertain to all lines of business
Telephonic case management
Telephonic case management (TCM) is an early intervention program by which
a registered nurse obtains a comprehensive assessment in order to design
a return-to-work plan that benefits all parties involved. The telephonic
case manager—a medical disability specialist—works collaboratively
with the claims specialist in a program called “dual handling.” The
goal is to deliver services that result in quality and cost-effective medical
management of lost-time workers compensation claims
Prescription processing services
Prescription process services (PPS) is a prescription drug managed care service
that handles an injured worker’s drug needs through the entire outpatient
continuum of care.
Early intervention return-to-work
program
The early intervention (EI) program is a return-to-work (RTW) program that
helps injured employees return promptly to work, primarily by proactively
providing their physicians with job analyses (JA) early in the disability.
The job analyses describe the work environment and the accommodations that
can be made by employers. With such information, physicians may be more
inclined to safely release injured employees to work sooner.
Durable medical equipment program
Our durable medical equipment (DME) program enables our nurses and claims
specialists to purchase durable medical equipment and supplies for our
claimants at discounted rates. Those items include wheel chairs, hospital
beds, crutches, splints, braces, supports, prosthetics, respiratory services,
infusion therapy, custom seating, MRI & CAT Scans, TENS Units and other
stimulators, whirlpools, home care, etc. CorVel coordinates delivery of
the products.
Catastrophic case management
Catastrophic and complex medical conditions are infrequent, but can be very
costly and result in poor outcomes without specialized management. Our mission
is to achieve superior outcomes on the most complex serious injuries. Harleysville
has a team of experienced nurses and partners on catastrophic and complex medical
claims in workers compensation.