Our 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.
- Description 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.
IT staff design and build customized systems for managing and submitting claims. They will work with your current platform, build and maintain your EDI connection, set up an FTP site, email and even facilitate paper solutions.
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.
PPO Access Network
Our 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. Our network consists of 5639 facilities and 32,149 physicians across the Midwest. The CompAlliance PPO network provides coverage across Kansas, Missouri, Iowa, Arkansas, Nebraska, and Illinois.
PPO Lease Network
Our strategic partnerships with PPO lease networks means you have access to a comprehensive network of credentialed hospitals and clinics, across Kansas, Missouri, Iowa, Arkansas, Nebraska and Illinois for increased coverage.
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 Medcare-Related Services
- Full service custodial administration of MSA accounts
- Comprehensive Structured Settlement Service
- Medicare Conditional Payment Negotiation
Services offered to worker's compensation, STD/LTD carriers, employers and attorneys include medical and vocational case management, "expert witness" and loss of earning capacity assessment, and ergonomic assessment and consultation. In addition, we assist employers with return to work program development and program enhancements.