Workers’ Compensation

For over a decade, Cost Containment Solutions has been designing custom Managed Care programs for Workers' Compensation clients. Each program is specifically tailored to individual needs to ensure that a TPA, an insurance company, a State Fund or a self-administered company has a program that maximizes medical cost savings. In fact, our review process, while being sensitive to turnaround issues, is completely focused on maximizing savings through a comprehensive review process consisting of fee schedule application or U&C reduction, application of state-specific healthcare rules, utilization review, and PPO discount application.

First Report of Injury (FROI)

The process begins when an injury occurs. Utilizing our EDI-based FROI reporting system, each party involved in the claim is notified of the injury within the first 12-24 hours. Early intervention allows Cost Containment Solutions to ascertain the necessary course of action right from the start. We work quickly to:

• Determine the appropriate treatment plans based on established clinical guidelines.
• Channel the injured worker to the PPO provider for added savings.
• Begin the medical review process.
• Assign a Case Manager based on information received from the client and the information collected from the first notice.

Bill Review

Technology is our leading edge. Utilizing our state-of-the-art software, medical bills are guaranteed maximum fee schedule discount on the first pass. Inherent to the system is sophisticated computer logic for reducing medical bills down to state mandated fee schedules. After all the rules and values are applied, the system automatically flags the appropriate bills for UR, then finds a PPO provider from any one of several national networks utilized by Cost Containment Solutions.

Utilization Review

Each medical bill is reviewed against a database of clinical guidelines with regard to length of treatment and appropriateness of care. Complex cases are reviewed by Registered Nurses or Staff Specialists.

Case Management

The Case Management department will work with the payor and the injured worker to develop specific RTW objectives based on the clinical review data. Through the Case Manager's expertise, the needs of the patient and the payor are combined to produce the most cost-effective, clinically sound and quality-driven patient-centric outcome.

Vocational Evaluations

When an injured person is disabled from employment, Cost Containment Solutions can provide vocational counseling services to facilitate either a change in present position or discover alternative employment opportunities.

Reporting Outcomes

Ultimately, Managed Care has produced an immense amount of clinical and financial data. Utilizing leading-edge technology, Cost Containment Solutions can design specific reports based on client need.