WORKERS' COMPENSATION

Programs that result in savings every step of the way.

Medlogix® workers’ compensation programs offer employers an integrated proactive approach to effectively managing work-related injuries and help control escalating medical and indemnity costs. We serve as your medical claims management managed care and PPO partner, guiding each case to optimal MMI and RTW outcomes. From the time of injury through the end of the treatment path, the Medlogix® case manager ensures the injured worker receives timely and medically necessary treatment 24/7 and 365 days per year.

Our Workers’ Compensation services are powered by our proprietary, web-based case management and bill review software, featuring a customizable, user-friendly platform and real-time access to the ongoing management of a claim. Progress may be tracked on nurse medical case management, case status, provider billing and RTW status. Automatic alerts are issued for a change in work status, compensability and more. Users receive individual secure logins so adjusters and case managers have access to all file activity in real-time.

Services

Information

Three ways to report an injury:

Report an injury online.
Fax your completed Claim Form to 609-631-7736.
Call 800-293-9795. Use prompt 1.

Please remember to have the following information when reporting:

Name of employer
Name, address and social security number for the injured worker
Employee’s current wages
Current contact numbers
Injured workers’ job title and department
Date, time & description of injury

No Medical Treatment Requested

Fax your completed No Treatment Requested Formto 609-631-7736.

WORKERS' COMPENSATION SERVICES

First Report of Injury

Our First Report of Injury services make it easy for employers to report on-the-job injuries and initiate the workers’ compensation claims process. Medlogix® provides 24/7 claim intake via web referral, fax or phone. Additionally, we complete all state-required accident forms and submit via secure EDI to the appropriate parties. Treatment management is initiated with triage at time of injury and continues through treatment paths and facilitates timely and medically necessary treatment which is appropriate for the work injury.

PPO Networks/Panel Development

Medlogix PPO solutions provide national access to in-network providers who are highly skilled in diagnosing and treating automobile and workplace injuries. This begins with our proprietary flagship CHN PPO, a leading preferred provider organization serving the northeastern United States with a premier, highly-credentialed network of over 140,000 provider locations. The CHN advantage includes in-house credentialing, customized network and panel development and on-going data integrity initiatives.

By partnering with select regional and national PPO networks that achieve high levels of credentialing, accessibility and cost savings consistent with our standards, Medlogix PPO delivers a seamless, coast-to-coast competitive edge to the customers we serve.

Program Features:

National access to over 750,000 credentialed provider/facility locations
Custom Network and Panel development
State Certifications/compliance
Contracts specifically cover Auto, Workers’ Compensation and Group Health
837 EDI, XML/Web services options
Electronic EOB
Streamlined Arb/Appeal Support
ROI Reporting

Telephonic Case Management

Medlogix’s powerful Medical Management Solutions provide Nurse Case Management for the Workers’ Compensation, Automobile and Group Health customers that we serve. Our results-oriented focus and timely evaluations have a positive impact on both the cost and duration of the claim. Treatment management is initiated with triage at the time of injury and continues through all treatment paths. Communication is key. Nurse Case Managers provide constant communication with the adjuster, treating provider, employer and injured party throughout the claim. A proactive course of treatment is mutually agreed upon and an appropriate return-to-work program is implemented through a cooperative team effort.

Field Case Management

For complex or catastrophic cases, or treatment that is not progressing as expected, the direct oversight of a Field Case Management medical professional provides valuable guidance. Medlogix’s solution includes nationally certified Registered Nurses, CCM or CRRN, who assess and coordinate treatment by working with medical care providers, employers, attorneys, injured persons and their families to ensure appropriate, quality healthcare services are delivered in a cost-effective manner. The result is decreased hardship to the injured party and their family and reduced financial exposure for insurers. Medlogix’s FCM Services are available for Workers’ Compensation, Group Health and Auto lines of business.

Program Features:

Highly Experienced Nurse Field Case Managers
Early identification and assessment
Goal-oriented Case Management
Discharge planning
Comprehensive ROI Reporting

Medical Director Review

For cases that require a physician review to determine medical necessity, Medlogix® provides access to highly-credentialed medical directors to provide professional guidance regarding the appropriate treatment of worksite injuries. Medlogix® offers a highly credentialed panel of medical directors in all appropriate specialties, which includes numerous medical directors on-site at Medlogix®’s operations center.

Lifetime Cost Projections

Requested for serious injuries and catastrophic claims, Lifetime Cost Projections provide a comprehensive evaluation of current and future treatment needs and expected medical costs associated with a claimant’s treatment plan. Medlogix’s Medical Management professionals perform an extensive file review including medical history, to deliver a detailed Cost Projection Analysis that adjusters use as a tool to establish proper file reserves. Medlogix’s Lifetime Cost Projection Services are available for Workers’ Compensation, Group Health and Auto lines of business.

Program Features:

Thorough Case assessment
Medical records review
Contact with injured party, care givers and product suppliers
Evaluation of future treatment needs and costs
Life Expectancy Projection
Detailed report with electronic submission

Medical Bill Review

MyMedlogix- our proprietary fully-integrated Medical Bill Review software provides a seamless, paperless, web-based platform through which all processes flow through one integrated system. Customers efficiently and securely manage all claim activity in real-time 24/7. Most importantly, our Bill Review platform meets all local, regional and national jurisdictional requirements.

MyMedlogix contains several robust rules engines that can be customized to support client-specific needs by coverage, jurisdiction and SIU, to name a few. Our platform reprices provider, facility and ancillary service bills while determining diagnosis relationship and properly coded billing patterns against the corresponding covered loss; thus maximizing efficiency and savings to our customers.

Medlogix’s fully integrated Bill Review solution include the following add-on services* to optimize program results:

PPO Networks
Code Review
Medical Bill Audit
Bill Negotiations

*Services are customizable by region and can be implemented on a combined or stand-alone basis

Program Features:

Turn-key solution- no installation required
Secure, user-friendly web portal
24/7 access to information to track activity in real time
Electronic EOB
Adjuster EOB review/editing options
Transparent Mailroom, Scanning, Data Capture solutions
Arb/Appeal Support
ROI Reporting

Code Review

To bolster our comprehensive Medical Bill Review solution, Medlogix offers CPT Code Review services to ensure provider billings are not unbundled, fragmented, up-coded, unrelated or improperly coded according to national and regional billing practices.

Medlogix’s expert team of Certified Coding Professionals review CPT-4 and ICD-9/ICD-10 diagnosis and treatment codes for outpatient services to assess and resolve inappropriate billing practices. Codes that are flagged for review can be customized based upon customer need and are triggered during the bill review process. Medlogix’s Code Review Services are available for First and Third Party Auto as well as Workers’ Compensation lines of business.

Program Features:

Expert team of certified coding professionals
Full review of HCFA 1500 or UB92 and supporting medical documentation
Detailed revision of EOB with line item explanation
Provider contact (if necessary)
Arb/Appeal Support
ROI Reporting

Medical Bill Auditing

For bills where compensability, medical necessity or excessive charges are in question, Medlogix’s Medical Bill Auditing Services provide a sound solution.

Medlogix’s team of highly credentialed Nurse Auditors perform extensive reviews of Provider and Facility bills to ensure all billed services include appropriate supporting documentation and are causally-related to the claim.

Audit results are compiled and presented in a detailed narrative report to include an EOB worksheet which outlines eligible/ineligible charges. Medlogix’s Medical Bill Auditing Services are available for First and Third party Auto as well as Workers’ Compensation lines of business.

Program Features:

Easy Referral via secure, user-friendly MyMedlogix web portal
24/7 access to information with built in alerts
Audits performed by highly credentialed Nurse Auditors
Detailed narrative Audit report/EOB
Arb/Appeal Support
ROI Reporting

Bill/Negotiations

When a PPO contract is not available, Medlogix’s medical management solutions are further enhanced with a negotiation program designed to reduce the cost of out of network providers both on a prospective and retrospective basis. Our highly-skilled negotiators employ data points such as UCR, Medicare, utilization history and in-network contracts to successfully negotiate with non-network hospital, physician and ancillary health care providers. Signed LOA’s are obtained for all negotiations. Medlogix’s Bill Negotiation Services are available for First and Third Party Auto as well as Workers’ Compensation lines of business.

Program Features:

Highly-skilled negotiators with expertise and knowledge of rate levels
Signed Letters of Agreement
Prospective and retrospective negotiations
High rate of Success
ROI Reporting

Independent Medical Exams (IME)

When you need an independent, objective assessment to determine the medical necessity of treatment, Medlogix’s IME solution is the answer. Our robust, multi-specialty offering of IME providers deliver objective assessments while demonstrating fairness and respect for the injured person. Our highly-credentialed network includes over 35,000 IME providers representing all relevant medical specialties. Medlogix’s IME Services are available for First and Third Party Auto as well as Workers’ Compensation lines of business

Program features:

Easy Referral via secure, user-friendly MyMedlogix web portal
Scan and store all documents on-line
Schedule coordination
24/7 access to track all activity in real time
Immediate notification if appointment is missed
Nurse QA of Report
Concise defendable reports
Medical expert testimony available
ROI Reporting

Peer Review

Medlogix’s® comprehensive Peer Review network spans all provider types and delivers a like- specialty, retrospective review of provider billed treatment to determine whether care provided was medically necessary and causally related. Medlogix® utilizes credentialed specialists who are board certified in the same specialty as the requested medical review. Findings are documented in a detailed narrative report of all provider findings.

Peer Review providers are required to have their own functioning practice and must be willing to testify in the event of a dispute.

Services include:

Quality assurance review by a nurse to ensure all questions have been answered and clinical documentation has been cited
Conclusive determinations on the issues of medical necessity and causality
Turnaround time of 5-7 business days
Full compliance of all state regulations