Download - CompPartners E-Brochure v2

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Page 1: CompPartners E-Brochure v2

Partner. It’s more than a part of our name.

It’s how we do business.

Page 2: CompPartners E-Brochure v2

It all started with a simple idea...

Partner with employers, the medical community and payers to get injured employees the best possible care in the shortest amount of time.

It’s the right thing to do. Doing these things gets injured employees back to work sooner. Turns out it also saves money for employers and payers.

CompPartners’ portfolio of services is based on this simple yet powerful philosophy. We have proven it works time and time again since our company was founded in 1998.

We have established a solid reputation for excellent service and quality results. Our services provide customers with peace of mind and lower overall costs.

It’s quality you can measure.

Now CompPartners has expanded beyond workers’ compensation into group health and other insurance services all with the same goal: Excellent service to our customers and to their customers.

With CompPartners, partner is more than just a part of our name.

It’s how we do business.

Page 3: CompPartners E-Brochure v2

NETWORK MANAGEMENT SOLUTIONS

The CompPartners approach to network management reduces costs, ensures the timely return to work of injured employees, and reduces litigation. How do we do it? We create strategic partnerships with clients like you who are committed to return to work and with the medical community. These two elements are critical to successful claim outcomes. We get everyone focused on returning to work, expedited delivery of medical services and quality care. It’s all about partnership. We work with you to design a custom network and offer a conscientious approach to managing workers’ compensation injuries.

We start by partnering with the medical community. Studies show medical professionals who specialize in occupational medicine have the greatest success treating work-related injuries. Physicians and specialists who are experienced in treating occupational injuries understand the importance of expediting appropriate care. They also understand the need for communication and setting attainable goals. We have contractual relationships with leading national networks. Having access to the best physicians and allied professionals in the country allows us to customize a network solution that fits your specific needs.

The bottom line is that experience translates to lower costs, higher return-to-work rates, satisfied employees and less litigation.

Next, we partner with our employers. Customers who are committed to early return to work reduce the overall costs of work-related injuries. We get everyone focused on the same common goals. How? By streamlining communication and offering rapid and succinct communication with all stakeholders.

Finally, we partner with payors to design unique network solutions. Through a complete array of leading national networks, physicians and specialists experienced in occupational injury and illnesses are available to you and your injured employees. We work with you to design a customized network based on our exclusive network management model. Ours is the most effective network management approach available in the industry. Why? Because we focus on careful selection of network providers specifically for your business.

Our exclusive network management model was developed expressly for workers’ compensation with a keen focus on expediting delivery of medical services to injured employees. Our model accelerates the communication process, helps gain prompt access to medical treatment for injured employees and allows efficient claims handling for claims administrators.

Network solutions available: •MedicalProviderNetworkMPN-California) •HealthCareOrganization(HCO-California)certifiedsince1998 •HealthCareNetwork(HCN-Texas) •AnArrayofNationalNetworkContracts •PharmacyPPONetworkwithaccesstoover50,000pharmaciesnationwide

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Page 4: CompPartners E-Brochure v2

UTILIZATION REVIEW

When it comes to Utilization Review, CompPartners has learned that our customers are most concerned about: timeliness, cost savings, communication and quality. Our UR service integrates the clinical experience of our highly qualified nursing staff plus URAC-certified Peer Review. Our UR serviceaddresses medical necessity and appropriateness of treatment by delivering timely review and recommendations for treatment.

What can you expect from CompPartners utilization review?

Timeliness. In many states, UR timeframes are mandated by state regulations. CompPartners has developed a system to ensure that every review is completed timely and follows state mandates.

Cost Savings. The UR process helps achieve cost savings, while ensuring that injured employees receive appropriate medical care.

Communication. Our process includes communication tools to relay timely communication to all parties i.e. adjusters, providers, treating facilities, and injured employees.

Experienced Nursing Staff. Our highly qualified team of registered nurses receives ongoingtraining and continuing education on compliance and regulatory changes.

Medical Director Oversight. MedicalDirectoroversightandtrainingofURservicesensuresthataccuratedecisionsaremadebased on evidence-based medicine and appropriate guideline application.

The Utilization Review program addresses medical necessity and appropriateness of treatment for: •ProspectiveReview •ConcurrentReview •RetrospectiveReview •SecondOpinionReview

Utilization Review services are used when you need to take a “snapshot” of a particular aspect of a claim to ensure everything is on track. For example, a review is done on a requested medical intervention, looking at appropriateness of treatment based on evidence-based medical guidelines.

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Page 5: CompPartners E-Brochure v2

PHYSICIAN PEER REVIEWCompPartners offers unbiased, independent peer review services utilizing a standardized process and an aggressive quality assurance program.

AsaURAC-accreditedIndependentReviewOrganization,CompPartnersenjoysbusinessrelationshipswith some of the most prestigious insurance carriers, self insured employers, and third party administrators in the country. Our peer review program maintains excellent quality standards in the areas of timeliness of reports, satisfaction, and appeals overturn rates.

What can you expect from CompPartners Peer Review? •Nationalnetworkincludinghundredsofmedicalspecialistsandalliedprofessionals representing essentially every medical specialty. •Timely,accuraterecommendations •Specialty-matchedreviewswithin48hours •Determinationsandrecommendationsupportedbyevidencebasedmedicine •DefensiblereportsthatmeetURACstandards •Superiorcommunicationandcustomerservice •Compliancewithstateregulations

CompPartners physician peer review services includes the following: •Workers’Compensation •STD/LTD •Medical/LegalOpinions •GroupHealth •AutoLiability

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ACCREDITEDINDEPENDENT REVIEW ORGANIZATION

Page 6: CompPartners E-Brochure v2

MEDICAL CASE MANAGEMENTCompPartners takes a different approach to case management. In the best interest of our customers, we provide medical case management services only in cases where we feel we can truly impact the outcome of the claim. Our nurses have the expertise to identify the most appropriate intervention, deliver the best outcome and provide faster return to work.

What can you expect from CompPartners Case Management? •Returntoworkisaddressedfromthebeginningoftheclaim •Casemanagementonlyontheclaimswecandramaticallyimpactorperyourrequest •Ournursesarepatientadvocates,ensuringappropriatecareandtimelytreatment •Nursesuseevidence-basedguidelinestoidentifyappropriatetreatmentaswellas disability durations •Nursesstreamlinethecommunicationprocess,communicatingtoallinterestedparties (claimsadministrator,treatingphysician,employer,injuredemployee) •NurseshaveaccesstoourPeerReviewnetworkfordeterminingappropriatetreatments •ReturntoWorkiscoordinatedforyourinjuredemployeesbyourskilledteamof professional case managers •Experiencednursingstaff—ourhighlyqualifiedteamofregisterednursesreceives ongoing training and continuing education on compliance and regulatory changes •Increasedemployeesatisfaction •Reducedlitigation •Oursystemwarehousesajobbankofallmodifieddutiesavailablewiththeemployer •CaseManagerscoordinatethesuccessfulreturntofullormodifieddutybyactingas an intermediary between the treating physician, the appropriate employer representative, and the injured worker •Bi-lingualcapability

Case Management services are used when you need management of treatment, expedited delivery of medical services and premium quality care for injured employees.

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Page 7: CompPartners E-Brochure v2

INTEGRATED MEDICAL MANAGEMENTCompPartners offers a comprehensive solution for all your workers’ comp needs. From prioritizing claims from the onset of injury to payment resolution to getting employees back to work, CompPartners iswithyoueverystepof theway.Acompletely integratedmedicalmanagementsystemhelpsyouunderstand your risks and allows you stay ahead of the curve when it comes to controlling your workers’ comp costs. This program is tailored to your specific business and maximizes your ability to control claims costs.

Services include: •FirstNoticeofInjury •Claimprioritization/referralmanagement •Customnetworksolutiondesignedespeciallyforyourbusiness •Networkmanagementservices •ComprehensivemedicalmanagementservicesfocusingonReturntoWork •Telephoniccasemanagementservices •Utilizationreviewservices •Physicianpeerreviewservices •Medicalbillreviewservices

What can you expect from the CompPartners Integrated Medical Management service system?

•Morecontroloveryourprogram •Lessadministrativeburdenandrelatedcosts •Loweroverallclaimscosts •ExpeditedReturntoWorkforyourinjuredemployees •Proactivecommunicationwithallstakeholders •Regulatorycompliance •Improvedemployer-employeerelations

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FNOI

CUSTOM NETWORK SOLUTION

MEDICAL BILLREVIEW

MEDICAL CASEMANAGEMENT

UTILIZATION REVIEW

PHYSICIANPEER REVIEW

Integrated Medical Management Solves Your “Return To Work Puzzle”

Page 8: CompPartners E-Brochure v2

MEDICARE SECONDARY PAYER ACTCompPartners’ new CompProjections division offers a comprehensive suite of products designed to supportcompliancewithMedicare’sSecondaryPayerActincasesettlementsandprojectionoffuturemedical costs for worker’s compensation claims, including Medicare Set-Aside Analyses, FutureMedicalCostProjections,andDrugUtilizationReviews.

Medicare’severchangingdemandscancauseconfusionanduncertaintyinclaimssettlements,thusit is imperative that youentrust awell-qualified companywith the taskof handling yourMedicareneeds.CompProjectionsprovidesacompleterangeofservicestomakecertainthatbothMedicareandtheEmployer/Insurer’sbestinterestsareconsidered.

Our services include: •MedicareandSocialSecurityDisabilityEligibilityVerification •MedicareSet-AsideAnalysisReport(MSA) •SubmissionofMedicareSet-AsidetoCMSforApproval •FutureMedicalCostProjections(FMCP) •PhysicianPeerReview/DrugUtilizationReview

What can you expect from CompProjections’ Medicare Set-Aside Analysis and Future Medical Cost Projection services?

•Unsurpassed Customer Service DiscussionofMSAreferralswithknowledgeablestaffabletoassistyouindetermining what is needed in terms of services and documentation in each case

•Exceptionally fast turnaround times MSAscompletedandreturnedtoyouwithin10workingdays;expeditedMSAs, within3to4workingdays

•Thorough, organized, carefully researched reports ClearandconciseinformationpresentedconsistentwithCMSrequirements anddefensiblemedicalcostprojectionsutilizingfeeschedulesandCMS historical determinations

•Customized services according to your particular requirements MSAs,FMCPs,andDURsdesignedaccordingtoyourcompany’sspecificneeds

•Electronic or Paper-based medical records collection Acceptanceofrequiredmedicalrecordandpayouthistorydocumentselectronically viaemail/FTPoronsiteretrievalandcopyingbyoneofourknowledgeablestaff

CompProjections is dedicated to providing the necessary evaluations and reports to assist in the effectiveresolutionofallclaims.AndwhileMedicareSet-AsideshaveprimarilybeenutilizedtoresolveWorker’sCompensationclaims,manypayersarenowbeginningtoutilizethemforLiabilityclaimsaswell.

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