MAJOR ISSUES FOR POST-AWARD & SETTLED WORKERS COMPENSATION CLAIMS
- Ongoing, expensive treatment
- Case Management no longer actively involved
- Treatment performed without prior authorization
- Changes in treating physician or multiple treating physicians
- large adjuster caseloads; difficult to closely monitor treatment
- High prescription drug usage
Medical and Pharmacy costs have continued to rise, while claim Frequencies have decreased.
- Medical Costs increased on average 5% to 5.5% per year from 2004 to 2009.
- Claim rates for workers’ compensation experienced a 4% decrease in 2009
- Pharmacy costs rose 6.5% in 2009
Let BHN’s specially trained Nurse Reviewers partner with your claims staff to develop a "Forensic Approach":
- Assess the claim
- Identify Issues
- Select Medical Management Partners
- Utilization Management
- Case Management
- Physician Peer Review
- Utilize Treatment Guidelines
- Develop a Strategy
- Implement the Plan
BHN’s Nurse Reviewers will:
- Develop a Comprehensive Initial Review of the claim and past medical treatment;
- Offer recommendations for Cost Containment strategies;
- Coordinate Case Management And/ or Utilization Management;
- Provide follow-up as needed