Managed Care

Forms and Tools

Click on any button to download a PDF document or be directed to another website. If you have any questions, please do not hesitate to contact us.

TOTAL Care Management

TOTAL Care Management is the managed care division of Hewitt Coleman & Associates, Inc. Our staff members are registered professional nurses focused on the medical resolution of illnesses or injuries.

Our nursing staff offers large case management, wellness and disease intervention for the smaller employer, STD medical management, utilization review and precertification, workers’ compensation case management, integrated return to work programs, medical bill processing, nurse negotiated savings, DME/ancillary services discounts, and pharmacy point-of-sale-card programs, coupled with utilization oversight.

Our goal is to contain the financial exposure of the disability claim by unifying the most appropriate resources to positively impact the disability duration, medical utilization and quality of care for the disabled individual.

PPO Network

Medical Providers Committed To Treating the Occupationally Injured

Known as the premiere workers’ compensation preferred provider network, Coventry is our partner of choice offering occupationally oriented providers, national coverage and a service driven approach to continually enhance network capabilities and ensure provider/facility active practice status and credentialing.

All employer groups contracted with Hewitt Coleman have access, via our web site, to electronic directories and Worksite Posters to locate participating providers.    Find a PPO Provider

If the providers you currently utilize are not participating members, complete the following form and First Health will initiate discussions regarding provider membership.  Nominate a Provider

Pharmacy Management Program

Through strategic partnering with EXPRESS SCRIPTS, Hewitt Coleman has implemented a pharmacy management program to establish cost containment and drug utilization parameters for workers’ compensation beginning with the first prescription.

The benefits include:

  • Pharmacy management of all medications
  • Control from the point-of-prescription-fill by a list of approved medications
  • Assurance the injured employee receives prescribed medications with no out-of-pocket expense
  • Increased compliance with medical treatment plans
  • Decrease in litigated cases due to disgruntled employees
  • Utilization review of pharmacy program by a Clinical Pharmacist in conjunction with the TCM nurse
  • Discounts on medications prescribed
  • Detail reporting by Employer Group, by employee, by medication, and by prescribing physician
  • Online medication reference

Click here to Look up a Medication

Nurse Case Managers

At the center of Every Workers’ Compensation Claim is an Injury Event.  We believe medical expertise teamed with our adjusters is crucial to a positive outcome. Who’s Managing Your Claims?
Our in-house nurses:

  • either possess or are eligible to sit for national rehab certification.
  • include bilingual  Spanish-English nurses.
  • have at least 3 years in the field of workers’ compensation.
  • are all Registered Nurses.
  • achieve a Return-To-Work outcome on 92% of all cases.

We offer medical expertise to partner with our adjusters. Each claim is reviewed by a Registered Nurse to identify barriers to recovery. A plan is essential to success.  From the medical review, an action plan is formulated and communicated to all parties with the collective focus of communicating goals with the injured worker and their families; involving the injured worker and their support system; decreasing the disability duration, optimizing functionality and achieving a successful return to work outcome.
We believe when the right thing is done, everyone wins.

Our Goal:  Helping to put the pieces back together again.

To make a referral, click:  Managed Care Referral

Nurse Negotiator

Catastrophic Claims , Prosthetics, Orthotics, Chronic Pharmacy and Out-Of-Network Claims Can Mean Big $$$$$$
Let us Help – We have a team of   aggressive, skilled nurse negotiators who will address the challenge of containing medical fees for Catastrophic and Out-Of-Network billings. Our goal is to maintain costs savings without compromising the delivery and/or quality of medical care.  Direct provider negotiations have produced significant savings ranging from 20%-60% reduction from Gross Billed Charges.

Utilization Review

Was that procedure medically necessary? Was there objective data and diagnostics to support the service? Did it meet Plan Stipulations or W/C Guidelines? Let us ask the right questions BEFORE the check goes out.

A Registered Nurse reviews a provider’s request to deliver medical services in order to determine the medical necessity and appropriateness of the intended medical service and that of the Group Health plan stipulations and/or workers’ compensation guidelines. Certification Reviews include inpatient admissions, outpatient services and/or procedures. 

Short-Term Disability Management

Employee Benefits, Production Costs, Temporary Staffing and Plan Over-utilization can translate into a Major Expense.
Are your employees confused about FMLA vs. STD?   Let our nurses manage your Short Term Disability Plan per plan intent. 

Short Term Disability and Absence management is offered to employers who do not currently manage their STD programs from a disability standpoint.  Program flexibility allows TCM to offer disability management services for an entire workforce or on a case by case basis. 

Employers participating in our Short Term Disability management programs have seen as much as a 43% reduction in over-utilization, a decrease in disability durations and dramatic reductions in lost production revenues.

Our services quickly pay for themselves.  If your STD Plan is being over-utilized with repeat absences and claims, we can help.

Short Term Disability Consult to Pay

If you just want our opinion regarding a Short Term Disability Application, then this is the service for you…

Not all submissions for short-term disability benefits are valid.  To ensure that benefits are utilized as intended and are limited to qualifying conditions, the consult-to-pay service is offered to specifically address each submission’s uniqueness.  The medical diagnosis is reviewed for compliance with the client’s specific plan design attendant with the projected disability duration.

Large Case Management

Catastrophic, Terminal, and Complex Disease Claims need special attention. We can tie the loose ends together.

Our Registered Nurses coordinate the medical care for the more complex, chronic, or terminally ill individual.  Services may include negotiation of fees for medical services, alternative treatment arrangements, air ambulances, transplant coordination, Home Health care, medical equipment, and chronic pharmacy management.  The nurse case manager will work closely with the stop-loss carrier and employer to continue cost containment efforts while preserving treatment integrity.