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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.
Workers Comp Service Description Source: Harleysville Insurance Web site |
