Medical Management Program

We provide reasonably priced, high-quality medical care to maximize efficient medical recovery.

Medical Bill Review

Medical bills are reviewed for by a professional for compliance with industry standard billing rules, reviewing injury connection to claim, and billed charges are processed for payment according to fee schedules or usual and customary charges. Medical bills can be subject to nurse review, specialty review and negotiation.

Medical Networks

Medical networks are available in all jurisdictions with qualified providers who understand Workers’ Compensation and our return to work requirements. In those states where direction of medical care is permitted, we work closely with the injured worker in locating qualified treatment.

First Fill and Retail Pharmacy Card

Employers can issue a temporary pharmacy identification card to an employee at time of injury, which helps the injured worker avoid out-of-pocket expenses when he/she obtains medicine. Pharmacy benefit cards are provided to injured workers to secure prescriptions at our network of more than 62,000 providers. Our key national pharmacy network partners include Walgreens, CVS, Rite Aid and Wal-Mart.

Durable Medical Equipment and Mail-Order Pharmacy

Durable medical equipment is provided to injured employees at contracted rates that reflect significant discounts. We offer a mail-order pharmacy program with direct billing to us.

Telephonic and Field Case Management

Telephonic Case Management ensures that a trained medical professional can work closely with the injured employee, the employer, medical providers and the claims professional. A nurse case manager can assist with medical provider selection, arrange medical appointments and coordinate an injured worker’s return to work.

Our Field Case Management service provides intensive in-person medical management of complex claims. Nursing professionals meet with the injured worker and agree on treatment plans with the medical providers that help the injured worker reach the highest level of functionality as quickly as possible.

Utilization Review

Utilization Review ensures that the proposed treatment plan is appropriate for the injury.

In mandatory Utilization Review states, we have access to a processing system that scrutinizes each request according to state treatment guidelines. It can also review and approve routine care. Exceptional treatments are routed to nurse reviewers and medical specialists. The system is able to immediately facilitate the scheduling of approved diagnostic testing, durable medical equipment and physical therapy.

Diagnostic Testing

A specialized MRI/CT-Scan network made up of providers throughout the country is accessible through a toll-free number. We save, on average, 30% below fee schedule and usual and customary charges.

Catastrophic Case Management

Catastrophic injuries require highly specialized, extensive care and our Catastrophic Case Management program provides it at the top medical facilities in the country.