Intercare Insurance Services

DISCOVER OUR INTEGRATED CASE MANAGEMENT

Case management is a collaborative process that assesses plans, implements, coordinates, evaluates and manages options and services to meet injured worker’s health care needs through communication and available resources to promote quality and cost effective outcomes. Intermed’s integrated program includes aggressive return to work planning by determining the physical demands of the job, availability of transitional work assignments and is focused on the injured worker’s ability to work in a modified or restricted setting versus disability.

Call-A-Nurse Triage Program

This program is offered to our clients who require collaboration in assessing treatment options for their employees. Often, emergency care treatment can be very expensive and patients often wait very long period of time in the emergency room while others with more immediate needs are treated. Our Call-A-Nurse program provide additional assistance to our clients by having a trained and licensed nurse help in assessing treatment options immediately after an injury. This not only helps the client provide prompt and effective care but will also help in reducing their cost.

Field Case Management

While we do not employ field case managers, our Telephonic Case Managers evaluates every situation to determine when field case management maybe beneficial. Field case management is outsourced to one of the approved Field Case Management Vendors on our panel on a task assignment basis and managed by our Case Managers to ensure appropriate outcome.

Telephonic Case Management

	In-house nurse case managers are a proactive task force, providing Intercare and our clients with in-depth specific expertise that allows for excellence in analysis and coordination of a workers’ compensation claim.

	Intercare’s nurses are strategically placed within the claims units to foster a team approach in the claims process. Our nurses “triage” each new claim and offer suggestions on how to proceed on the medical component of the claim. This triage is performed without any assessed fee.

	Because our nurses are integrated within each claim unit, they have specialized agility in their direct dealings with the injured employee, treating physician and employer. Our nurses are experts in the intricacies and formalities of occupational medicine, workplace accidents and injuries, the best courses of treatment and the administration and regulation of the workers’ compensation system.

Utilization Review

	InterMed has been providing utilization review services since 1998, with strict adherence to all national and jurisdictional laws and guidelines since our inception. Utilization review is conducted by our Medical Case Managers, who are typically Registered Nurses. Our proprietary Utilization Review management software works in concert with the claims system by capturing all medical data elements of the claim. InterMed distinguishes itself from others with our integrated approach and recognition that the best outcomes are achieved utilizing the expertise of the claims examiner and the Utilization Review manager. The Utilization Review managers do not authorize, deny, or modify physician requests without first discussing with the claims examiner.

	InterMed’s technology captures fees/charges for these services as well as realized savings, treatment protocol, nurse notes and other pertinent data all on a monthly basis.

Peer Review

	If the U/R nurse is unable to authorize treatment, or the treating doctor is uncooperative in providing necessary information regarding treatment or disability status, a referral is made to a member of the Panel of Peer Review Physicians for evaluation and recommendations. The Physician or Chiropractic reviewers prepare a written review with the rationale for authorization, delay, modification, or denial recommendations including contacts with the primary care physician or any other ancillary healthcare providers.

	Any authorization, delay, modification or denial of treatment plan recommendations is to communicated to the Claims adjuster and alerts the designated bill review provider of the finding in order for any billing received for denial, delay, modified or authorization of treatment is adjudicated appropriately.