Workers compensation
Harleysville’s managed care
programs are focused on providing benefits for covered employees having
occupational disabilities, while containing costs. We use a network of
preferred physicians and other health care providers to provide quality
medical care and products at reasonable prices. More detail on these
programs follows.
All Star Risk Management Program
Harleysville’s
All Star Management Program is at the forefront of our managed care initiative.
It supports our customers in the following cost-containment goals:
-
Reporting
job-related injuries to Harleysville within 24 hours
-
Using CorVel’s
preferred physicians for treatment of job-related injures
-
Providing injured
employees with modified duty for early return-to-work
Prompt reporting
The most important aspect of
containing costs on workers compensation claims and providing quality
service to our customers and injured employees is prompt reporting of the
loss. It enables us to investigate and pay benefits promptly to avoid
litigation, manage disabilities more effectively and apply our
cost-containment programs as soon as possible.
Claims are reported to our central claims unit at 800.892.8877,
available 24 hours per day.
Physician panels
We provide our workers compensation policyholders with physician panels
to treat their employees who have job-related injuries. Our panels are made
up of health care providers who participate in CorVel®
Corporation’s preferred provider organization (PPO).
Customer participation ensures quality health care and controls
costs. We are committed to enabling the highest possible access to
CorVel’s national
network of preferred providers.
The
CorVel PPO provides the following services to our customers:
-
Access to
a nationwide PPO network
-
Creation
of physician panel postings
-
Repricing
of medical provider bills
-
Monthly
management reports
-
Ability to
nominate providers to the PPO
Our ultimate goal is to assure that injured
workers are provided with quality health care, which in turn will control
medical and indemnity costs through the channeling of treatment into the PPO.
Pharmacy program
Our pharmacy program is a prescription drug managed care service that
handles an injured employee’s drug needs through the entire outpatient
continuum of care. We provide our
customers with access to a nationwide network of participating pharmacies,
which includes most of the major pharmacy chains.
The service enables injured employees to purchase prescribed drugs at
discount rates, with no out-of-pocket expense to the employee.
Durable medical equipment program
Our durable medical equipment (DME) program enables our nurses and
claims specialists to purchase durable medical equipment and supplies for
injured employees at discounted rates. Those items include wheelchairs,
hospital beds, crutches, splints, braces, supports, prosthetics, respiratory
services, infusion therapy, custom seating, MRI & CAT Scans, TENS Units
and other stimulators, whirlpools, home care, etc. We provide this service
through a national network of DME providers, who also coordinate delivery of
the products.
Medical cost projections
Medical cost projections (MCP) assist the claims staff in setting,
adjusting and anticipating realistic reserving needs for any file in which
medical needs are catastrophic or serious in nature. They are an estimate of
the medical care and associated costs that a claimant might expect to
undergo for the duration of the disability. MCPs pertain to all lines of
business.
Telephonic case management
Telephonic case management (TCM) is an
early intervention program by which a registered nurse obtains a
comprehensive assessment in order to design a return-to-work plan that
benefits all parties involved. The telephonic case manager—a medical
management specialist—works collaboratively with the claims specialist in
a program called “dual handling.” The goal is to deliver services that
result in quality and cost-effective medical management of lost-time workers
compensation claims.
On-site case management
Medical management specialists help our field claims staff evaluate,
manage and make recommendations regarding the medical and/or vocational
aspects of workers compensation, personal injury protection and bodily
injury files. Our philosophy of case management is based on a cooperative
approach involving all parties, i.e. Harleysville, the injured party, the
injured party’s family, the medical provider, employer, etc.
Catastrophic case management
Catastrophic and complex medical conditions are infrequent, but can be
very costly and result in poor outcomes without specialized management. Our
mission is to achieve superior outcomes on the most complex serious
injuries. Harleysville has a team of experienced nurses and partners who
work on catastrophic and complex medical claims in workers compensation.
Chronic
pain management program
Chronic
pain claims are very costly and result in poor outcomes without specialized
management. The goal of our chronic
pain management program is to facilitate optimal recovery, assure
appropriate treatment and support, and to avert unnecessary treatment.
Harleysville has a team of experienced nurses and partners
coordinating our chronic pain program. Some of the case types included are
failed back surgery, chronic regional pain syndrome, fibromyalgia,
depression and/or substance abuse.
For
more information about any of these programs, call Kate Hinkle, assistant
vice president—workers compensation claims, 800.523.6344, Ext. 8702.
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