Our main objective is complete customer satisfaction in providing managed care services for the workers’ compensation industry. We can tailor any of our products to meet your specific needs. While all case management vendors provide you with information, our goal as a strategic business partner is to ensure you are provided not only with the facts but with an analysis that allows the claims professional to make informed decisions that lead to successful case closure.
CompAlliance staff receive ongoing in-house training and education and have a clear understanding of the scope of their role as determined by state licensure and CCM and CCRC standards. CompAlliance staff recognize the adjudication role of the adjuster.
By working as a team, we proactively ensure appointment coverage regardless of the consultant’s schedule, to obtain timely information regarding diagnostics, treatment plans, projections and ensuring the physician focuses on functional capabilities both at home and at work at each appointment, with the goal of a successful RTW and MMI whenever possible. CompAlliance case managers are trained to be proactive, not reactive.
CompAlliance utilizes Predictive Modeling as part of evaluating any diagnosis and treatment plan, providing more accurate timelines and figures for the adjuster when calculating reserves. A first level of UR is built into our CM process as a result of utilizing ODG guidelines and providing analysis of the Evidence Based Guidelines.
All communications to the Recovering Worker (RW) transferred to Plain Language to ensure understanding. CompAlliance utilizes bilingual staff whenever possible or available. Languages spoken by our Case Management Staff are Spanish and Polish. All communications prepared for the recovering worker are translated to these languages and are also transferred to Plain Language.
CompAlliance staff are located throughout our territory; this minimizes travel time and costs are lower! All CompAlliance medical case managers are licensed in the states in which they practice, and our vocational consultants are masters prepared. These educational levels ensure the knowledge base and expertise you expect!
CompAlliance advocates use of and provides accurate and detailed video Job Analysis by a Vocational Consultant as a key to early RTW.
All CompAlliance Medical Case Management Supervisors are nationally certified in URAC approved certifications, which assists in facilitation of quality oversight of your cases.
CompAlliance Medical Case Managers are respected by attorneys and physicians in the claims arena; resulting in good working relationships and timely communication with all parties. CompAlliance consultants communicate with the account via email within strict timeline standards unless otherwise requested.
CompAlliance Vocational Specialists are nationally certified in both vocational and ergonomic fields and provide services to the workers’ compensation industry. CompAlliance Vocational Services produce successful outcomes. We define success as:
- Job offered but not accepted
- Documented lack of adherence to rehabilitation plan
- Ability to help bring to settlement with LMS information
- Testimony resulting in an objective decision during the judicial process
The CompAlliance Rehabilitation Plan expects Recovering Workers to spend 5-8 hours daily involved in job search activities including:
- Employer contacts
- Submitting resumes
- Completing applications
Consistent follow-up on the RW’s employer contacts ensures adherence with the Rehabilitation Plan. The consultant integrates online monitoring of the Job Search activities with telephonic and in-person meetings.
CompAlliance Employment Consultants provide aggressive job search activity; devoting a full-time effort to contacting employers on behalf of recovering workers. CompAlliance Vocational Staff also advocate the implementation of an Early Intervention Vocational Program.
A Nurse Triage Program for the workers’ compensation industry facilitates immediate telephonic contact with a Professional Nurse on a 24/7 basis, for your injured employees, while providing immediate accident reporting to the carrier, if requested, as accidents are reported to the supervisory staff at your place of employment.
NurseNow is the 24/7 Nurse Hotline that you call if you believe your employee has experienced a work-related injury. By contacting NurseNow your employee will receive direction regarding their medical treatment from a nurse specializing in work related injuries. In the NurseNow program all injuries, no matter how slight, are to be reported to the immediate supervisor on the day of the incident and then directed to the 24/7 Nurse Hotline. Basic First Aid steps still apply.
911 is still to be contacted in the case of severe emergencies, such as loss of consciousness, the Injured Worker is not breathing, there is pronounced bleeding, or there is extreme pain you cannot identify.
Triage Begins When the Employee or Supervisor Calls the Dedicated Hotline Number
The nurse will interview the caller to obtain pertinent information including nature and severity of event, personal and employment information and assess medical condition. The nurse provides medical recommendations utilizing patient care guidelines and nursing judgement. The nurse facilitates direction to an appropriate medical provider if necessary.
The nurse emails initial notice to designated contact if requested. If requested, claim can be created by accessing specific claims system. If requested, the first report of injury can be completed and provided to designated contact.
The nurse performs triage services to ensure the patient receives appropriate and timely medical care while minimizing any lost time of regular work hours. The nurse will follow up with the injured worker and authorized medical provider to assess appropriateness of care while coordinating information is provided to the claims professional.
Advantages of a Nurse Triage Program
Quality medical recommendations are provided at the time of the event, minimizing financial impact and duration of claim. Timely Incident Reporting – First Report of Injury is created for you to assure timely reporting. A preferred provider can be used – avoiding outside fees.
Most importantly the employer is not responsible for making medical decisions for the employee.
In catastrophic or emergent situations, a field nurse case manager may be recommended and assigned with adjuster authorization.
CompAlliance believes Utilization Management/Review provided for the workers’ compensation industry is an effective tool utilized to assure the recovering worker receives the most appropriate treatment, with a goal of return to health and function.
CompAlliance believes there is a difference between a proactive Utilization Management approach and a reactive Utilization Review approach when facilitating appropriate care. CompAlliance’s URAC accredited Utilization Management program has shown outstanding results and great satisfaction for our clients. Our philosophy of collaborating with providers reduces the overall claims cost by expediting the most appropriate treatment in order to speed recovery and Return to Work.
Conversely, when a Utilization Review program is focused on denials, they often ADD to the cost of a claim by delaying recovery and adding friction to the claim. The CompAlliance Utilization Management Program views treatment as a continuum and examines whether the treatment plan is the most effective and appropriate to achieve resolution of the recovering worker’s condition.
- CompAlliance Nurses and Physicians collaborate and negotiate with the treating physician to develop a treatment plan most appropriate for the recovering worker, rather than evaluating a treatment request in a vacuum.
- When the CompAlliance nurse receives a treatment request for an injury that would indicate future treatment would be required, rather than evaluate only the initial treatment request, the nurse reaches out to the provider to discuss the treatment plan as a continuum. As a result, when future treatment requests are submitted from the provider, the additional treatment will have already been reviewed with our Nurse or Physician and agreed upon as appropriate; a timely approval can be provided, thereby expediting treatment.
- CompAlliance does not believe we need to deny care in order to show savings. We look at all details related to the case and understand timely treatment will yield better outcomes for the recovering worker and employer in the long run.
- CompAlliance researches current regulation to ensure clients adhere to current regulatory requirements, changing trends, and to manage costs appropriately.
The CompAlliance collaborative approach fosters excellent relationships, expedites recovery and reduces overall costs.