Medical costs are a significant portion of total workers’ compensation claim expenditures. In order to control these costs, CSI offers the largest network of doctors and hospitals in our region. Many of these doctors and hospitals are also included in the provider networks of our parent company, Independence Blue Cross.
CSI’s workers’ compensation networks are significantly discounted below the state-mandated fee schedule, are geographically dispersed throughout the region, include the appropriate specialties for occupational care and are specifically contracted with CSI. These providers are contractually obligated to cooperate with our managed care team as well as providing timely medical information.
MANAGED CARE SERVICES
Medical Case Management
CSI’s nurse case managers are physically located side-by-side with our adjusters. They function as an integral part of our claims team and are supported by our full time Medical Director, Dr. Jennifer Dragoun, M.D. All claims are reviewed by our nurse case managers. They assist the adjuster in compensability determination by providing an evaluation and feedback of the medical documentation. They, along with our Medical Director, interact with the attending physician, other medical providers, the employer, and the employee to ensure the most practical, highest quality of medical care is provided. Our managed care program utilizes set standards of occupational care in determining the appropriateness of medical treatment and estimating durations of disability.
Medical Bill Review
A thorough review of Workers’ Compensation medical bills is an important component of medical cost containment. Closely reviewing each individual bill prevents over-billing and ensures that negotiated provider network discounts are received and that the bills paid are appropriate for the claim being accepted.