First Call Workers' Compensation Program
First Call is a medical cost containment solution for carriers and
self-insurers which manages the initial medical treatment and the return to work
of injured claimants. R.N. Case managers, working in conjunction with the
employer's Claims Department, assess the claimant’s treatment needs, direct care
wherever possible, and work to remove barriers to a safe return to work.
First Call provides telephonic case management, treatment authorization and
one point of contact by assigned Certified R.N. Case Managers. The program
integrates with a full range of services including field case management,
medical bill auditing, IME coordination, PPO network management, and return to
Components of the program are available either as a package or individually,
and all services can be customized to meet the needs of the client.
Case Management: From the first report of injury, Case Management RNs assess
the medical needs of the claimant and authorize treatment according to accepted
criteria. Care is directed to the employer's provider network or to non-network
providers when appropriate. The Case Manager works closely with the claims
administrator, employer and physician to facilitate a prompt recovery and return
to work. In serious cases, field Case Managers can provide “hands on” injury
management and return to work assistance.
Preferred Provider Network: URS has access to PPOs with extensive resources
throughout New Jersey, New York and Pennsylvania. It also maintains its own
specialized network of providers, and can include the employer’s preferred
providers in the panel.
Independent Medical Examinations: Over 3,500 physicians in New Jersey and
10,000 nationally are available to perform IMEs to determine necessity of
further treatment, take over treatment, or determine permanency. Pre-established
fee ranges assure IME cost effectiveness, and dedicated IME Schedulers work to
provide a timely and quality report.
Medical Bill Auditing: All bills are re-priced according to the PPO rate as
well as the applicable medical fee schedule. Bills that are not within the
network or which contain questionable treatment are audited for appropriate
coding and pricing. Dedicated Auditing RNs perform all services.
First Call brings the functionality of an in-house R.N. Case Manager to the
Claims Department, making the medical management effort a visible and meaningful
part of the claims adjudication process. All case management actions are
documented in our claims system, as are case status notes, updated disability
duration projections, target dates for return to work, and other important
information relevant to the claim.