Medical Case Management
At ISCC, we prioritize effective medical case management to ensure the well-being of injured workers while containing costs. Our approach involves medical triage procedures that direct claimants to network providers for medically necessary treatment. We have a dedicated team of in-house medical case managers who collaborate closely with our adjusters on the same claim platform.
Utilization Review
Our in-house utilization review specialists play a crucial role in helping our clients meet state mandates and manage the care of injured workers using the most appropriate and widely accepted medical protocols. Our utilization review procedures encompass pre-certification, concurrent and retrospective reviews, and physician assessments. Oversight by a seasoned medical director ensures the effectiveness of our utilization review process.
Medical Bill Re-Pricing
In the realm of medical bill re-pricing, ISCC employs rigorous cost-containment practices for our clients. Our cutting-edge technology thoroughly reviews all submitted bills, identifying opportunities for fee schedule and customary reductions. This sophisticated bill review process involves a comprehensive analysis of usual and customary treatment, accurate coding, bundling and unbundling assessments, and code compliance checks.
Furthermore, we employ nurse audits to conduct detailed reviews of complex medical bills. When combined with the utilization of ISCC’s preferred provider organization (PPO) network, this service delivers exceptional savings for our clients, surpassing the results achieved by many other TPAs.
Preferred Provider Networks and Prescription Benefit Management
ISCC offers a comprehensive preferred provider organization (PPO) network to our clients, providing pre-negotiated provider discounts ranging from 5% to 35%. Our state-approved networks are advantageous for clients in the initial treatment of injured employees.
Additionally, ISCC offers a prescription benefit management (PBM) program. This innovative program ensures that claimants receive prescription cards at the outset of a claim, streamlining access to approved medications. Our PBM also includes a first-fill program, expediting access to necessary medications for work-related injuries.
