Irvine, Calif.-based CompPartners has partnered with Emerald Claims Management to provide intake and triage services to injured employees. The program expedites the delivery of medical services to claimants and reduces lost-time claims, the companies said.
“The most critical time for managing medical care is the 24-to-48 hour period after an accident,” said Jamie Davis, director of claims for Emerald Claims Management, a workers’ compensation third-party administrator (TPA). With the CompPartners program, a 24/7 call center receives and processes the claim and a triage case manager is assigned while the injured employee is still in the process of seeking medical care. Triage and field case managers triage the injuries and help claimants get in promptly to see the most appropriate physicians, educate providers on the claimant’s job requirements, and then work with employers on modified duty. When lost-time occurs, nurse case managers accompany patients on physicians’ visits.
Emerald Claims Management implemented the intake and triage program in July 2010 with TransCare Corp., a medical transportation company serving the Mid-Atlantic with more than a dozen operating locations and 2,500 employees.
“We operate in a fast-paced environment with claims opening and closing very quickly,” said TransCare risk manager Steve Miller. “Our employees receive care immediately after an accident and we wanted to eliminate any lag time involved in their subsequent medical visit.”
Now, a nurse contacts the emergency room or occupational health clinic, obtains the diagnosis, talks to the injured employee, alerts the adjuster, triages care, schedules appointments with providers, and stays in touch with the employee throughout the process. The injured employee knows who is handling the claim and understands the whole process right away. “This all happens within 24 hours — actually it’s usually within eight hours of the accident,” Miller said.
Relying on CompPartners’ expertise in medical management and delivery frees the adjusters to handle bills and pay the claims, according to Davis, resulting in an improved closing ratio. Comparing TransCare’s July 2010 closing ratios against the previous year showed 93 percent of medical-only claims occurring in July 2010 closed within a month, while only 5 percent of claims in July 2009 had closed in a month.
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