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Workers’ Compensation laws vary from state to state as do the specific state laws governing these claims. Adapting to particular state laws is a significant challenge for our clients.
Our understanding of regional jurisdictions is one of the unique strengths of MCN. Our medical network addresses Workers’ Compensation claims in all 50 states. Table of Contents Independent Medical Evaluations Medical assessments are MCN's core competency. They provide answers to questions about the medical nature, cause and treatment of injuries. MCN offers these services nationwide for insurance claims professionals, self-insured groups, regional and national government agencies and attorneys. The physician reviews all appropriate medical records, takes a detailed history, documents patient complaints and answers the requestor’s questions based on objective medical evidence. Peer Reviews Claims often raise questions regarding the delivery, appropriateness or necessity of medical services. When a face-to-face evaluation is not required or possible, consider MCN’s Peer Review services. MCN will compile complete medical histories, have a qualified physician consult and review all medial records and provide a comprehensive report. Depending on client protocols, MCN may ask that the physician contact the treating provider for further clarification in the case. Early Assessments Early Assessments allow claims managers the ability to achieve an early understanding of examinees that fit the profile of a long duration injury. This provides the claims manager with a tool to better determine appropriateness of care and further diagnostic testing. The insurance carrier then has the tools necessary to discuss the case with the treating physician and understand the return to work issues and need for household help or equipment. At the time of scheduling for the initial examination, a follow-up evaluation is scheduled so that the case can be closely watched during its preliminary stages. Early assessments are often used to monitor soft tissue injuries. Second Opinions MCN works directly with OWCP District Offices who have direct responsibility for processing Federal employment claims. We interface with claims managers in the District Offices that adjudicate incoming claims to determine eligibility for compensation payments; manage claims in which eligibility has been established; determine wage-loss compensation payments for covered disability or death; and process payments for allowed medical and vocational rehabilitation services incurred in the treatment of injured workers covered under the Federal Act. MCN provides active practice physicians to assist in the medical determination of these claims. Functional Capacity Evaluations (FCEs) FCE’s are an invaluable tool in providing an objective and complete assessment of an employee’s current level of physical functioning. They can also be tailored to assess a specific diagnosis, physical impairment, or ability to perform the essential functions of a specific job. The results provide valuable additional objective evidence when used in conjunction with an Independent Medical Evaluation. Medical Bill Review MCN brings efficiencies to medical bill review processing, with leading solutions for workers’ compensation and auto injury medical bill review.
MCN provides complete outsourcing through our Cost Management Service Bureau, offering solutions to fit each client’s need. With extensive EDI and scanning capabilities, MCN can provide a user-customizable workflow. We take client defined claims handling rules and automate the process through the use of decision management software. Our clients inform us of the dramatic improvement in claims management productivity, resulting in bill review accuracy and consistency. The powerful decision engines use an extensive database of state fee schedules and the industry’s largest number of automated, national (and regional) PPO contracts to help you obtain the maximum savings on every bill. MCN can assist your claims manager’s workload by increasing workflow automation, getting the right bills to the right resources every time.
In the implementation process, MCN can conduct a study of physician payment history to aid in the selection of the most appropriate preferred provider by jurisdiction down to the zip code level. We make sure that the right provider is selected for the right state.
Do you have customers that want require Telephonic Case Management triage when a claim meets certain criteria? What about Utilization Review parameters? Our Decision Management program provides rules that trigger at key points in the claim process, helping you automate the identification of actions that need to be taken throughout the claim. Our rules building team, works in conjunction with your experience and criteria to assure that needs for these services are consistently identified and captured. We can automate actions that you choose in your own claims management process. Bill review customers who use our system find it an excellent vehicle for increasing efficiency and ultimately reducing the costs of conducting business.
MCN has developed this program in response to today’s need to go beyond Preferred Provider discounts and bill reductions. We are on the leading edge with our approach and look forward to working with you in implementing it on your claims. PPO Management MCN delivers one of the most sophisticated PPO management tools to its medical bill review clients. Based on our client’s geographic needs MCN can configure an unlimited number of PPO networks down to a specific zip code. We take client claims data and analyze which group of networks has the deepest penetration and discounts in a given location. Using this data MCN can come up with a layered approach, giving our clients the maximum coverage and savings in a given region. Let MCN analyze your claims data to determine your company’s maximum savings configuration. Below are some of MCN’s PPO partners. Decision Management MCN’s Decision Management Solution provides the over-arching workflow, database management and audit tracking capabilities to simultaneously orchestrate any number of unique decisioning processes for enforcement of client directed rules, these could include the following:
Treatment protocols
Treatment benchmarking
Utilization review parameters
Case management enforcement/criteria setting
SIU Protocols – link with databases
PBM protocols and linkage
Network development protocols By attaching this decision management tool to your medical bill review services, MCN is able to link the enforcement of its client’s claims management protocols to the overall financial management of the claim. The ensuing results in taking this step toward further automation are staggering. Claims managers can handle more claims more efficiently with underlying improved results for both the claimant and the carrier.
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