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