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Managed Care has become a critical component to Workers’ Compensation claim administration and provides very effective cost control benefits. Qual-Lynx is committed to the implementation and management of this care component for those clients requiring these services.
Telephonic Case Management begins from the onset of the claim. Registered nurses perform a telephonic triage to verify and ascertain relevant information from the claimant, the medical provider and the employer. They determine and communicate medical status, treatment plans, expected length of disability and the potential for alternative duty.
Field Case Management may be assigned on more severe claims or those that fit established protocol. Experienced occupational nurses maintain contact with the Medical Provider and the claimant, often attending medical appointments and working out treatment plans. The Field Case Manager assists the claimant in a number of ways by scheduling appointments, arranging transportation (where necessary) and developing realistic outlines of the claimant’s functional capacity for early return to work.
Medical and hospital bill audits are conducted on every submitted bill to insure that usual and customary rates are not being exceeded and all available discounts are applied before payment.
Utilization Review services are provided to control the costs of over-utilization, unnecessary medical treatment, and to insure that all treatment is consistent with the actual injury.
Qual-Lynx believes that the combination of care and claim management creates a win-win situation for the insured and for their injured workers by delivering a high quality of medical care with cost saving benefits.
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