Catastrophic Case Management

Services

Bill Review

Catastrophic Case
Management


Ergonomics

Field Case Management

Functional Capacity Evaluation

Future Medical & Rx Review

Life Care Planning

Non-Occupational Absence Management


Peer Review

Peer-to-Peer Intervention

Qualified Rehabilitation Consulting (QRC)

Return-to-Work Interactive Search Process

Technology

Telephonic Case Management

Task Assignments

Utilization Review


 

Catastrophic Case Definition

  • Amputation of any extremity
  • Brain injury
  • Burn injury requiring hospitalization
  • Electrocution requiring hospitalization
  • Heart attack, stroke, or coma
  • Injury requiring hospital stay
  • Paraplegics/Quadriplegics
  • Patient transportation by ambulance or life-flight
  • Reflex sympathetic dystrophy syndrome (RSD)
  • Serious spinal cord injuries

1. Initial Intake Work Flow

Immediately contact Excel to report a new loss using the following options.

Phone/Fax During Normal Business Hours

888 464 0044 phone
916 944 0211 fax
Refer to Excel >>

Referrals after 5:30 pm: Direct to Steve Smetana
916 276 1033 phone Fax:
916 779 1098 fax
SSmetana@excelmanagedcare.com

2. Information Needed By Excel Managed Care

Catastrophic Case Definition

  • Amputation of any extremity
  • Injury requiring hospital stay
  • Patient name
  • Social security number
  • Date of injury (DOI)
  • Date of birth (DOB)
  • Home address
  • Home phone
  • Employer name
  • Employer contact
  • Name and phone number of hospital and/or treater
3. If additional information is required, the nurse case manager will contact the adjuster.

Excel Nurse Case Management Responsibilities

  • Respond to all catastrophic referrals with an onsite visit to the hospital by the Nurse Case Manager (NCM) as soon as possible but no later than 24 hours after referral.

  • Communicate all referrals not only to the NCM but also to the NCM Supervisor and the Excel Medical Director. This initial triage ensures medical oversight to all aspects of the claim.

  • Provide a Post Visit and Day 4 written report as well as daily oral /email reports to the Claims Staff.

  • Work with the adjuster to provide contact and medical advice to the family and employer to support, aid, and comfort.

  • Maintain ongoing contact with medical staff, injured worker, family, employer, and claims staff throughout the duration of any hospital stay.

  • Provide discharge planning appropriate to the patient’s needs, and coordinate durable medical equipment (DME), pharmaceuticals, and other ancillary services as needed through the client’s network providers.

  • When needed, perform a home assessment prior to the patient’s release and report the findings to the claim professional.

  • Establish and maintain a productive working relationship with all parties – including the treating physician, during the duration of aftercare treatment, provide oral reports at all significant milestones during recovery, and provide monthly written reports every 30 days until closure.

  • Provide all support and coordination to the parties to thoroughly evaluate the earliest and most appropriate means of returning the employee to either modified, alternate temporary, transitional, or full time work.

  • Conduct a 60-90 day roundtable session with supervisor and adjuster.

  • Prepare a monthly management report that captures the date of the referral as well as the name of the patient, adjuster, and nurse and the type of injury and year-to-date (YTD) cost savings.

  • Work with the claim professional to establish accurate reserves for large loss reporting purposes.

     
     
Case Management Services Utilization Review Non-Occ Absence Management eManagedCare
Ergonomics Rx Reviews Bill Review RTW Services
   

   
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