Why We’ve Been Successful

• 24 Hr. “Point of Entry” Care Management
• Immediate Medical Care, Same Day Authorizations
• Engaged Provider Network
• Timely Communication
• Work Site Knowledge
• Effective Return To Work
• Support for Injury Prevention & Safety Initiatives

24/7 Point of Entry Care Management

• Claimants are required to call our 800# prior to seeking treatment unless their injury is “life threatening”
• Nurse Case Managers are available 24/7 to perform intakes and arrange immediate medical care and to educate provider of visit and opportunity for Return to Work
• Nurse Case Managers perform telephonic and field case management, often attending appointments with claimants when requested.

Same Day Authorizations No Delays in Treatment

• Provider requests for authorization managed on the same day received
• Nurse Case Managers make recommendations and requests to Claim Adjustor based on the NYS WCB Medical Treatment Guidelines and provide medical documentation to support request
• Arrangement made for testing, treatment within 24 to 48 hours (PT, MRI, etc.)

Engaged WC PPO Network

• Providers are expected to use  "best practice" PPO Practice Parameters and NYS WCB Medical Treatment guidelines for care
• Providers are educated and encouraged to define capabilities to allow transitional or non-restricted return to regular job duties
• Cooperate in the completion and return of the Patient Management Record

No “Black Holes”

• Full circle communication with the team after each claimant visit; Employee, Nurse Case Manager, Medical Provider  Claim Adjustor, and the Employer to address expected recovery
• Discussion with Employee, Employer, and Supervisor of work restrictions if a transitional work assignment is necessary.

Work Site Knowledge and Effective Return To Work

• Prior to Employer service start-up, the NCM performs Job Assessments at worksite and documents essential functions of each job.
• The information is stored in our database for future use in Return To Work decisions
• NCM collaborates with the Employer to identify transitional work opportunities

Support for Injury Prevention & Safety Initiatives

• Provide meaningful trends data: i.e.  Similar injuries, same job task or equipment used, same department, not using personal protection equipment.
• Active member of Safety Committee as requested.
• Work-site reintegration by Case Manager if needed.
• Ergonomic evaluations & training from on staff Physical Therapist / Industrial Specialist are available.