Our medical case management team works to achieve positive medical outcomes, minimize litigation and increase employee productivity. They use a four-point communication method involving injured worker, physician, employer and claims handler, keeping all parties informed of treatment plans and current status. Early intervention results in early and timely treatment and facilitates informed decision-making. These services include telephonic or field and full or task assignments.
- List of Medical Case Management Services
- Medical Case Management Teams
- Nominate a Provider Form
- Case Management Referral Form
Certified vocational staff assist employees when return to their previous duties following a work injury is not feasible. The CompAlliance vocational team offers career planning, skills analysis, job development and placement. We are proud to announce our Alternative Transitional Duty Early RTW program. Additionally, CompAlliance provides labor market surveys, residual wage earning studies and wage earning capacity testimony. The CompAlliance vocational staff provide detailed documentation of adherence or non-adherence to the vocational rehabilitation plan. Our Certified Ergonomic Assessment Specialists (CEAS) provide detailed Job Analyses and Ergonomic Assessments.
On-call nurses provide medical advice over the telephone to employees at all hours of the day. They assist with symptom assessment, urgent and non-urgent health advice, medical explanations, recommendations and information.
The CompAlliance Utilization Management program is philosophically different from traditional Utilization Review. It blends traditional UR with an effective Utilization Management program and is compliant with State of California regulations and is URAC accredited.
CompAlliance believes that Utilization Management when done well, is a strong alternative to an IME or a traditional UR. CompAlliance’s Utilization Management program has shown outstanding results and great satisfaction for all our clients. CompAlliance’s collaborative approach to Utilization Management saves you money on the cost of UR services while reducing your medical expenses and minimizing your exposure to penalties. Traditional UR Physician Review is also available.
Utilization Review / Physician Advisement
CompAlliance offers a team of Physician Reviewers that provide cost-effective, and unbiased medical reviews. We use physician expertise to determine medical necessity and appropriateness of care. Evidence based guidelines supporting the physician opinions are included with each report. Types of Review include:
- Prospective Review – pre-certification
- Concurrent Review – during episode of care
- Retrospective Review – after charges are billed
- Peer Review, if mandated by state laws
- Pre-Admission and Continued Stay Review
Surgical Cost Projections
Workers’ compensation experts provide a comparison of surgical costs among various providers to give you a clear picture of your injured worker’s expected care selections to assist you in projecting, calculating, and setting accurate reserves.
CompAlliance is proud to announce CompInsights; your source for cloud-based data analytics. IT staff design and build customized unique systems for managing and submitting your claims. They will work with your current platform, build and maintain your EDI connection, set up an FTP site, email and even facilitate efficient use and application of legacy paper solutions.
CompAlliance offers advanced analytical programs covering the full scope of available claim data. We offer dynamic dashboards for general reporting services, triggered data driven events, and the ability to tie in additional data sources for relevant data review. This service is powered by all CompAlliance business lines, and utilizes the latest machine learning and reporting technologies currently available. Nothing is off the table when it comes to customizing the solution that meets your needs!
Medical Bill Review
The bill review team works to maximize your benefit assuring you receive significant savings. They monitor the impact of claims, provide utilization and saving reports so you can actively manage and improve your outcomes. CompAlliance’s proprietary data analytics are customized according to the client’s needs and assist you in making informed treatment decisions. One example would be in assisting you in deciding whether to authorize treatment in an outpatient vs. an inpatient setting.
PPO Access Network
Recent research documents that all PPO Networks are NOT created equally. The Network to look for is outcome-based, highly selective and focused on excellent care. When the Network goal is to add as many providers as possible while only generating dollars off savings below fee schedule, you are not receiving the focused results you deserve! CompAlliance’s broad geographic coverage offers access to high-quality physicians, specialists, MRI centers, occupational, physician clinics, and rehabilitation centers and facilities, providing you with choices and quality services at discounted rates. But that is not the end of the story. Our data analytics look at the outcomes these providers obtain, allowing you to select a narrow network that focuses on the RESULTS you are looking for!
PPO Lease Network
Our strategic partnerships with PPO lease networks means you have access to a comprehensive network of credentialed hospitals and clinics.
Medicare Set Asides
Provided by MEDVAL. The MEDVAL approach – proprietary, completely integrated, and focused on in-depth medical review and attorney oversight – offers our clients simple, cost-effective settlement solutions for even their most complex cases.
Additional Medicare-Related Services
Full service custodial administration of MSA accounts
Comprehensive Structured Settlement Service
Medicare Conditional Payment Negotiation.