Managed Care

We combine first-rate care with cost-effective solutions to take care of the people taking care of business every day.

You never know when an employee may suffer an injury or illness that takes them out of commission. But with Comp MC and Comp RX, you can relax, knowing you have the plan in place to speed their recovery and prevent unnecessary loss.

Our comprehensive managed care program combines best-in-class claim handling with proprietary risk management systems to trim medical costs, shorten employee absence times and help our clients realize substantial cost savings.

When you’re ready for managed care that balances the needs of your employees with a healthier bottom line, see us for a detailed plan that includes the following…

Provider Bill Review

This premier service combines current state fee schedule revisions with the latest database for usual and customary charges to eliminate excessive and duplicate charges. In addition to insuring your regulatory compliance, bill review identifies billing infractions that might normally get lost in the shuffle, while customized rules make it easy to identify and divert predefined bills for specific injuries and procedures to a nurse case manager for review and challenge.

Preferred Provider Organization Networks

Our unique PPO strategy grants you special access to numerous national, regional and proprietary networks. We can also customize each specific program by incorporating client-negotiated provider discounts. This mosaic approach provides optimal network coverage with maximum savings, giving you more for less.

Specialty Bill Review

Specialized medical procedures can lead to exorbitant bills and excessive charges. This unique service uses robust data from more than 20 public and proprietary sources to provide the legal, medical and financial bill analysis required to ensure a re-pricing review that’s fair, reasonable, defensible and unique to your jurisdiction.

Integrated Pharmacy Program

Prescription drug costs now account for 12% of total medical claims. And they're on the rise, climbing faster than general medical inflation. Through Comp RX — an integrated pharmacy program linked directly to our proprietary claims software, we can capture "first fills" and adjudicate pharmacy claims directly online when they're dispensed. Studies show that first fills account for 80% of all pharmacy costs; therefore, any successful program must capture this event.

Our adjusters also have the ability to look up data from the pharmacy, doctor and patient via one screen, bringing together all the data required to make informed and cost-effective decisions. With this system in place, we can view drug information and pricing, recent reject history, recent claim history, and approve medications — all in real time, delivering the best care at the lowest cost.

Utilization/Disability Management

At CCMSI, we realize that proactive nurse case management can lower cost, improve care and help injured employees return to work sooner. Whether you use our proprietary nurse case management resources (available in select offices) or a preferred partner, we'll work with the nurse involved to establish and oversee a medically appropriate and cost-effective treatment plan to achieve optimal results.

Analysis and Savings Reports

For the best results, you need objective and definitive data to measure the success of your managed care program and fine-tune future performance. That's why we offer a full library of reports, allowing you to gauge any number of variables.

Request a Demo

Having trouble getting the data you want on your system? If your systems are falling flat, dragging on efficiency, accountability, and organization - let us know and we can arrange onsite demonstration and education sourced from 30 years of experience