Insurance

INFORMATION for INSURANCE ADMINISTRATOR

I. Type of Medical Service Request II. Identification of Patient Type III. To Make a Patient Referral IV. Interdisciplinary Medical Case Map

I. Type of Medical Service Request

A. Interdisciplinary Team Evaluation and Conference
for Care Disposition Recommendations

B. Programs

Functional Restoration Program
Chronic Pain Management
Early Intervention Program
Pre and/or Post Surgical Intervention
C. Specialized

Case Management Service
Behavioral Medicine and Psychological Services
Pharmacy Evaluation and Counsulting Service
and Detoxification Management
Physical Therapy and Occupational Therapy Services

Work Hardening
General Therapy
Hand Therapy

Nutrition Evaluation and Counseling
Acupuncture Treatment
Vocational Rehabilitation Counseling

II. IDENTIFICATION of PATIENT TYPE

Acute Patient:

Early intervention for medical management of high-risk patients
Surgical Intervention

Orthopedic Pre-Op
Orthopedic Post-Op

Patients who fail to progress within the guidelines
of standards of practice
Patients requiring medication management
Case disposition - medical discharge, return to work
Sub-Acute Patient

Patient with symptoms of both acute and chronic pain needing to become more functional
Case disposition - medical discharge, return to work
Chronic Patient

Patients with psychosocial issues complicating course of recovery
Patient showing little motivation or advancement to discharge and return to work
Medication management and/or detoxification
Case disposition - medical discharge, return to work
Special

Patients who require a controlled care environment
and focused medical team
Patients who geographically have difficulty accessing care

III. It Takes ONE Call ... (775) 828-5522
or eMail IHR

A. All New Patient calls and inquires may be directed to the Administrative Office at (775) 828-5522. In this one call we will obtain all information that is necessary for your request to be processed.

Claims Management Team names, i.e., Adjuster and/or Nurse. Applicable Voice and FAX numbers.

Patient name and telephone number.

Injured body part and a brief history of injury.
Type of service requested.
Patient Demographics.
When would you like the patient to be scheduled?
Arrange for records and films to be sent prior to initial visits.

If appropriate, you may speak with the Nurse Case Manager who will review the referral and discuss patient needs with you. You may jointly decide the evaluation process.

IV. "INTERDISCIPLINARY MEDICAL CASE MAP"

Comprehensive evaluation process with individualization of treatment recommendations.

Identification of appropriate team members and implement central coordination of medical team.

Medical Team, performs consensus reporting focused on patient function, early return to work and medical discharge.

Follow best practices and medical algorithms
Distinguish industrial versus non-industrial
Results oriented
Reach Maximum Medical Improvement (MMI) and
Permanent and Stationary (P&S) status
Predictable cost with focused healthcare utilization

Patient Participation and Commitment

Written Performance agreement, terms and expectations
Appointment schedule projected for treatment time frame
Required Personal progress monitoring reports
Medication management written agreement
Weekly and/or as necessary checkpoints with re-evaluation based on functional progress

Ongoing and weekly communications and re-evaluation of treatment progress.

Discharge process involving medical team consensus, patient participation, and claims team participation.

Care Map Evaluation with evolving adjustments and improvements based on patient outcome and feedback.

Patient Outcome Data Base and Patient Satisfaction Survey