1. Network Access including: Utilization Review First Report of Injury Re-pricing audit of provider bills 24-hour service access 2. Telephonic Case Management including: Immediate activation of case management Physician Referral within 24 hours Case Management triage including Employer, Employee, and Physician contact Initiation of Quality Assurance Programs Establishment of OPTIMIZE computer file Continuous updating of computer file Online access to information by TPA Physician treatment plan Pre-authorization of all therapies, diagnostics, etc. Cost Projections within seven (7) days of case initiation (if requested) Case Conferencing Multiple physician and therapy visits are set up on a priority basis Return to work program initiated from the onset Close monitoring of treatment by the case manager until maximum medical benefit is reached Continuous contact with the employer, physicians, patient, and all other related parties Ongoing Utilization Review and Quality Assurance 3. On-Site Rehabilitation Case Services: Catastrophic injury or indemnity assessment 4. Pharmacy services as needed
