• Employing a team of highly skilled and respected Nurse Case Managers, InterMed provides the utmost quality in managed care. The medical management team provides enhanced communication among all parties to facilitate appropriate quality of care while assuring that care is delivered in the most cost-effective manner for our clients.
   
• InterMed’s services help to reduce the overall cost of claims and increase the closure rate by negotiating treatment plans, customizing early return-to-work plans and eliminating unnecessary treatment and related charges. All claims receive initial nurse triage as part of our standard services and without a fee.

Integrated Medical Management

In-house nurse case managers are a proactive task force, providing TPAs and our clients with in-depth expertise that allows for excellence in analysis and coordination of a workers’ compensation claim.

• In-house medical case management services are provided by licensed RN’s and integrated with all claims units.
• Works directly with the payer’s claims department.
• Triage new claims for: Diagnosis validation, treatment plan, PPO/MPN direction.

Integrated Medical Management

• Three points of contact: injured worker, provider and employer.
• Works with the claim examiner to develop, negotiate and manage the treatment plan-of-action.
• Maintains medical control with the claim examiner.
• Channels provider into PPO/ MPN Networks, when possible.
• Validates treatment diagnosis.
• Assesses work capabilities/abilities.
• Proponents of Early Return-To-Work -- light duty/ modified duty/ usual & customary.

Managed Care Expertise

• Our nurses are experts in the intricacies and formalities of occupational medicine, workplace accidents and injuries, the best courses of treatment and the administration and regulation of the workers’ compensation system.
   
• On each and every claim, InterMed provides the medical support needed to verify that an injured worker is receiving quality medical care by an appropriate provider, in a timely and cost efficient manner. Because our nurses are integrated within each claim unit, they have a special capability to deal directly with the injured employee, treating physician and employer.

Managed Care Expertise

• Coordinated medical review and appeal processes.
• Experience in the workers’ compensation/occupational medicine system.
• Direct liaison with our Medical Director on all escalated issues.
• Formal Peer Review processes, when needed, by specialty.
• Employer support on Return-To-Work programs.
• Nurses and claims examiners work together to adhere to regulations, timelines and caps that apply to different types of medical care.
• Language interpretation services available.

Innovative Cost & Time Savings

• InterMed is an innovative organization that is vigilant in our pursuit of cost and time efficient case management, continually identifying ways to reduce our client’s medical costs.
• Early detection of high dollar claims.
• Reduction in excessive Permanent Disability.
• Enhancement of communication among all parties to facilitate appropriate quality of care in a timely manner.

Innovative Cost & Time Savings

• Assurance that care is delivered in the most cost effective setting.
• Prospective elimination of unnecessary treatment and related charges.
• Emphasis on Early Return-To-Work.
• Assistance to claim department to increase case closure rate.
• Assistance to claim department to decrease unnecessary indemnity & medical expenses.
• Priority given on lost time cases and high dollar claims.

InterMed "Best Practices"

• Case Assignment -- Measured by whether or not the case was assigned in a timely manner, to the appropriate level of expertise, and the medical triage was completed.
   
• Quality Contact -- "Voice to voice" contact made to the employer, medical provider, claimant or attorney within 72 hours (when indicated).
   
• Ongoing Contact -- The file reflects that all parties have received the appropriate follow-up.

InterMed "Best Practices"

• Investigation -- Initial, timely and complete enough to support the claims adjustor’s decision, re:
  • Compensability: What happened? How? Witnesses?
  • Medical Issues: Diagnosis Validation? Treatment Plan consistent with the diagnosis? Prior Injuries? Potential apportionment issues addressed?
  • Temporary Disability: Length of disability, if any, identified?
     
• File Documentation -- From triage to completion, on-going notes clearly describe the diagnosis, associated treatment, communications and plans-of-action.