Case Management

Case management within the Workers’ Compensation venue has achieved proven success by providing cost savings to clients and by fostering improved employee-employer relations.

 

Triad delivers an array of services, including:

• Telephonic case management, initial assessments and medical care plans on an immediate basis

• In-house Medical Treatment Guideline response

• GML 207 C and A Case Management

• Discharge planning

• Utilization review

• Coordination and administration of involuntary Disability Retirement Applications

• Early return to work programs inclusive of transitional job descriptions

• DME negotiation and coordination

 

Since it is not unusual for employees and employers to harbor mutual resentment in the wake of a workplace injury, case management involvement mitigates these feelings. Our case management model places the nurse in a facilitator role enhancing communication among the physician, employer and injured worker to smooth the way to a speedy case resolution with attendant cost savings.

 

Involvement with the care provider will facilitate and ensure that necessary and appropriate diagnostics testing and other procedures are timely scheduled. Feedback from providers can also be used to counsel employees and dispel any concerns.

 

For Triad’s Early Return to Work Program, our in-house Nurse Case Managers maintain constant communication with the injured worker and treating physician to obtain degree of disability, treatment plans and return to work status. If an injured worker is out of work or unable to temporarily perform their typical responsibilities, interim light or transitional duty is discussed with the injured worker. This helps initially set the expectation that the injured worker will return to work as soon as possible either in partial or full capacity. In addition to Nurse Case Managers, Triad Claims Adjusters also contact treating physicians to obtain current and future treatment status, any potential job restrictions and anticipated return to work dates. Triad maintains a >90% success rate with employee return to work and believes that employer participation in early return to work is a critical factor to a successful program.

 

Loss Control

Triad provides loss control services to assist clients in developing and implementing effective safety and health programs, which can help reduce overall insurance costs. We visit facilities and off-site projects to identify, as well as train employees to identify, current and potential hazards. We provide organizations with a full report analyzing the strengths and weaknesses of an employer’s overall safety and health program. We also provide organizations with statistical data that assists in identifying and focusing on departments or teams with the most frequent and costly claims.

 

Triad also provides organizations with a comprehensive understanding of the OSHA process and, if needed, the necessary procedures to comply with an OSHA citation. We also assist in the OSHA inspection process.

 

In addition to conducting safety and health seminars, we also provide training on topics that include:

• Active Shooter Training

• 6 Hour Defensive Driving Course

• Slip/Fall Prevention

• Fire Safety

• Preventing Workplace Violence

• Right to Know

• Use of PPE

• Safe Lifting Techniques

• Electrical Safety

• Ergonomics

• Blood Borne Pathogen Training

 

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Network Solutions
 

Bill Review:

Triad’s in-house bill review staff is trained on all fee schedules and any subsequent changes, including customary medical fees. Triad processes medical bills by utilizing network controls and cost containment systems to ensure bills are paid accurately and are causally-related to the claim. As a result, Triad clients typically experience an average savings of 50 – 65%.

 

Pharmacy Solutions:

Triad has partnered with AWPRx as our Pharmacy Benefit Manager, with Triad Claim Adjusters approving or denying prescriptions at the point of sale in real-time. This allows greater control and ensures prescriptions are causally-related to the claim. Step Therapy, Retrospective Utilization Reviews, Physician Education and Medication Therapy Management are just some of the ways Triad is succeeding at reducing prescription costs.

 

PPO Network:

Triad partners with numerous providers to create a cost effective PPO network to deliver savings to our clients. This includes One Call Care Management for radiological services and Optum Inc. for medical bill review, among others.