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

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

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.

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. 

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.

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.