Information Technology Solutions

Information Technology Solutions
You Choose:
CSAC Excess Insurance Authority
LWP
JT2
Intercare
Primary
Workers’ Compensation
Program
CorVel
York Risk
Services
Comparison of Claims
Administration Services
CSAC Excess Insurance Authority Primary Workers' Compensation Program
Comparison of Claims Administration Services
Remote Access to Claims System
Online 5020
Conversion of Data at No Charge
Direct Deposit of Disability Checks
LWP
X
X
X
X
JT2
X
X
X
Intercare
X
X
X
X
Corvel
X
X
X
X
York
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Communication with Injured Worker
Introduction/Get Well Card
Phone contact every 2 weeks while on TD
Calls prior to "bad" news e.g., claim denial, UR
denial
Calls prior to form letter being mailed
Calls upon significant events e.g., surgery
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Will send a nurse
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
On-site Meetings with Injured Worker
Get settlement documents signed, answer questions
On significant injuries within 90 days of injury
Have Catastrophic Injury Plan
Claims team respond to site, hospital or home
Assign Nurse Case Manager to coordinate care
WCAB Appearances
Hearing Representative Program
Examiner make appearance when it makes sense
Small Claims Court appearances on subrogation
matters
Arbitration/Mediation
X
File Reviews
Quarterly, in person (or telephonic) with examiner
and supervisor in attendance
Productive - report activity on POA since last review
with goal to be moving claim to closure
Litigation Review
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Know Medical Community in Member's Area
Meet with designated treating physicians/clinics
Ensure doc is aware of member organizational
culture, Return to Work program
Train docs on UR process and getting appropriate
treatment
X
X
X
X
X
X
X
X
X
X
X
X
X
X
CSAC Excess Insurance Authority Primary Workers' Compensation Program
Comparison of Claims Administration Services
LWP
Regular Roundtable Discussion Regarding
Claimants on TD
Regular Roundtable Discussion Regarding Large
Loss Claims
JT2
Intercare
Corvel
York
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Baseline
Plus 4%
Plus 11%
Reporting
Litigation rates
Benchmark reports
Management reports
Trending reports
Annual stewardship reports
Point-In-Time Reports
Annual Partnership Meeting
X
X
Training
Negotiating
Reserving
Case Law
Guidelines
Fraud/SIU
SB 863
ADA
Ed Code
4850
First Aid
Average Relative Cost
X
X
X
X
X
X
X
X
Less 15%
Less 7%
Office Locations
Sacramento
Glendale
Oakland
Manteca
Rocklin
Fresno
Orange
Pasadena
Contact Person
Phone Number
E-mail
Judy Adlam
415-384-0370
[email protected]
Theresa Fernandez
925-452-1309
[email protected]
Danielle Buri
916-677-2555
[email protected]
Roseville
Upland
Rancho Cucamonga
Oxnard
Camarillo
Valencia
Folsom
San Bernardino
San Diego
Orange County*
Stockton
Oakland*
Foster City
Stockton*
*Upon agreement of the parties
Charlie Green
Jody Gray
916-605-3803
714-620-1336
[email protected] [email protected]
LWP Claims Solutions, Inc.
Public Agency Claims Management
Our Promise
LWP promises to work with the utmost integrity and urgency to exceed our clients’ risk management objectives. We will move claims proactively and costeffectively to closure by securing aggressive medical treatment and facilitating return-to-work, thereby enabling our clients to retain productive employees with minimal impact to their businesses. LWP Results
Indemnity Claims — close 60% faster than the industry
Litigation Rates — 55% lower than the industry
Average Incurred Claim — 60% lower than the industry Hallmarks of Our Approach

Integrity and Transparency

Aggressive Claims Management Techniques

Examiners who are Empowered to think and make decisions

We start with the end in mind—Dual Track Diary System

Judicious use of vendors and resources

Unique blend of discipline and creativity—we balance customization with our proven Best Practices
 We integrate ourselves into the culture of our clients
WE DON’T PAINT WITH A BROAD
BRUSH—SERVICES AND CHOICES
ARE MADE CAREFULLY.
WE WON’T SPEND $1 TO SAVE
YOU 50 CENTS
Our staff has extensive expertise in Public Agencies:

LC Section 4850
 Presumptions

Education Code
 Utility and Transit Districts
Our Claims Offices
Sacramento, California
Glendale, California
What we offer

Results-oriented claims management

Fully integrated bill review

Utilization Review 
Telephonic Case Management

Field Case Management

Prescription Benefit Network coupled with an aggressive Pharmacy Management Program

Expedited Diagnostic Testing

Aggressive Lien Resolution Program

Physical Therapy Network

Transportation and Translation Network

Industry Leading SIU Program

Clinic Management Program
Contact Us
www.lwpclaims.com
Judy Adlam
[email protected]
(415)384-0370
Custom Solutions. Proven Outcomes.
What We Stand For:
At JT2 we adhere to strict moral and ethical principles
in our business and our relationships with Clients,
Employees and Vendors. Our success comes from
the strength of our values and the principles of our
company. Together, we are committed to providing
exceptional service with integrity.
Flexibility, Measurement, Performance:
We measure critical claim administration success
factors and performance in accordance with client
instructions to ensure that our work meets the goals
Each of our services has been tailored to meet the
needs of an ever-changing risk and legal environment.
OUR SERVICES
WORKERS’ COMPENSATION
CLAIMS ADMINISTRATION
GENERAL LIABILITY
ADMINISTRATION
Administration
Programs
MANAGED CARE SERVICES
INFORMATION AND
TECHNOLOGY
OUR CUSTOMERS
WHY JT2?
PUBLIC: SELF INSURED
PRIVATE – SELF INSURED
Companies
Performance
ALTERNATIVE MARKET
Staff
CORPORATE HEADQUARTERS
Stewardship
Pleasanton, CA
Claims Service Centers:
Committed to Continuous
Questions?
Contact:
Michael Ramser
Phone: (310) 775-1494 | Email: [email protected]
Tailored Services
SSAE - 16 Compliant
PARTNERSHIP
AT ITS BEST
ANALYZING EXPOSURE
RESOLVING OUTSTANDING ISSUES
The InterAct Program
BRAINSTORMING SOLUTIONS
In addition to regular 3-point contacts, RTW coordination, and file reviews, Intercare has
developed the InterAct Program as a new outlet for client participation in the claims
management process.
The InterAct Program brings key parties together to discuss claim status, medical
management plans, return-to-work possibilities, settlement strategies, etc.
These roundtable discussions are attended by Intercare’s claims team, managed care nurse,
defense attorney, Employer representatives, and other vendor representatives as appropriate.
Together we analyze individual claims to develop a collective strategy for medical management,
cost containment and the ultimate goal of resolution and closure.
INTERCARE HOLDINGS INSURANCE SERVICES INC.
Fresno ● Orange ● Pasadena ● Pleasant Hill ● Rocklin ● San Diego
www.IntercareIns.com ● (800)771-5454
INTERCONNECT
INTERCARE CONNECTS WITH INJURED WORKERS
• ON‐SITE BENEFIT MEETINGS – Intercare Adjusters visit your location for appointments with unrepresented injured workers. ENHANCE COMMUNICATION, REDUCE LITIGATION, AGGRESSIVELY PURSUE SETTLEMENT,
AND ACHIEVE CLOSURE SOONER! • THINKING OUTSIDE THE CUBICLE ‐ On‐site meetings promote a different dimension of communication, encouraging interactive dialogue to exchange ideas in a more amicable setting. The Injured Worker and Intercare Adjuster can discuss the Injured Worker’s questions regarding their benefits, settlement documents, or any other concerns they may have about their workers’ compensation claim. • WHAT ARE THE BENEFITS? – COST CONTAINMENT AT ALL LEVELS! Intercare Adjusters are able to proactively resolve issues before the claim results in litigation, help injured workers with their healthcare needs, and ultimately deliver appropriate benefits more quickly. Intercare Holdings Insurance Services Inc. Fresno • Orange • Pasadena • Pleasant Hill • Rocklin • San Diego WWW.INTERCAREINS.COM • (800)771∙5454 BUILDING PROGRAMS &
PARTNERSHIPS WITH A
PERSONAL TOUCH

MEDICAL BILL REVIEW

UTILIZATION REVIEW

NURSE CASE MANAGEMENT

DME NETWORK

INTERPRETERS ON CALL

MPN DEVELOPMENT AND MAINTENANCE
INTERMED COST CONTAINMENT SERVICES, INC.
PO Box 358, Roseville, CA 95661
(800) 307-5454
WORKERS’ COMPENSATION
CLAIMS SERVICES
Partnership ● Transparency ● Flexibility ● Results
Intercare’s approach to claims administration is both analytical and personal. We
separate administration from finance to obtain excellence in both areas, revealing
the most cost effective solution for your organization. Controlling the cost of an
indemnity claim through reduced time-loss, appropriate medical expenses, and
elimination of litigation and fraud is critical to your bottom line.
To achieve the best results for your organization, Intercare provides a broad array
of value added services, enabling you to customize a flexible program that
compliments your organization and improves claims handling efficiency and cost
containment at all levels. Services include:
• InterAct – Claim Committee Strategy Meetings
• InterConnect – On-site Adjuster Meetings
• In-house Special Investigations Unit
• Pharmacy Benefit Management Program
• Durable Medical Equipment Network
• MPN Development & Management
• Diagnostic Service Network
• Transportation Network
• Interpreters On Call
• MMSEA Reporting
INTERCARE HOLDINGS INSURANCE SERVICES, INC.
Fresno ● Orange ● Pasadena ● Pleasant Hill ● Rocklin
www.Intercareins.com ● (800) 771-5454
Workers' Compensation Management
Municipalities
CorVel offers a unique approach to claims administration and
cost containment for municipalities.
Our experience with
municipalities across the country provides an innovative,
integrated service model that controls claims by advocating
medical management at the onset of the injury.
Nurse
advocacy services are available by telephone before and after
working hours to ensure immediate access to care for your
unique mix of occupations that can include government
administrators, maintenance workers, engineers and planners,
parks and recreation, utility services, law enforcement and fire,
construction, and human services.
Our services decrease average claims costs and improve return
to work outcomes. CorVel offers a personalized treatment
program that uses precise treatment protocols – advocating
timely, quality care for municipal employees.
Claims Management
 24/7 nurse hotline
 Proactive smart triage at onset of injury
 Streamlined incident reporting
 Online access to reporting
Cost Containment
 Medical bill review
 Case Management
 Utilization management
 Expert negotiations
 National preferred provider network
 Vocational rehabilitation services
Benefits
 Reduce number of days lost from work
 Improve lost time to medical only claims ratios
 Increase bill review savings
 Decentralized business model
CorVel understands the unique needs of municipalities where budgets are a
major concern, along with diverse employment descriptions and job settings.
Our innovative solution combines claims technology with industry leading
medical cost containment for your existing safety program. Visit
www.corvel.com to learn more.
CorVel Corporation| 888.7.CorVel | www.corvel.com
CorVel’s systems are
easy to use and offer 24
hour access to all of
your claims data as well
as benchmarking
analysis and financial
reporting tools. Our
system leverages timely
information to keep you
within budget and injury
outcome goals.
It’s all about the
PEOPLE
Our people are specialists in providing
integrated workers’ compensation claims
administration and managed care services
customized for CSAC-EIA PWC members.
We focus on public entities.
We serve over 1,200 government agencies in California, including stand-alone cities, counties, school
districts, transportation districts, special districts,
pools and Joint Powers Authority (JPAs). We serve
over 100 PWC members, which includes 3 JPAs.
We communicate proactively.
We encourage daily interaction with your team and
periodic meetings, including annual meetings to review program performance and procedures. We also
keep you abreast of changes to the workers’ compensation system by publishing Perspectives, a
monthly newsletter that provides brief, easy-to-digest
information on industry changes or trends.
We deliver quality through PLUS.
We continuously measure results through a customized audit process, York PLUS. Every examiner is audited every quarter. These audits provide
meaningful findings to drive desktop behaviors
and are tied to performance reviews. Stephanie
Pinkley, your designated Claims Director, works
with the team to audit and train according to
CSAC-EIA guidelines.
Your
Leadership Team
Eric Tennison
Vice President
E: [email protected]

Daniel Rodriguez
Assistant Vice President
E: [email protected]

Barbara Esquivel
Assistant Vice President
E: [email protected]
We stay educated through Claims U.
We believe that training is one of the most important
ways we can invest in our people so they invest in
you. By keeping claims and management personnel
abreast of workers’ compensation law, we ensure
that they are equipped with the knowledge to
achieve the best outcomes on your claims. We have
customized training for your claims team to include
SB 863, fraud, CSAC-EIA guidelines, etc.
Claims Administration • Managed Care • Loss Control
www.yorkrsg.com
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We offer a full suite of
managed care solutions.
Our integrated services have a successful track record of controlling
costs without compromising the quality of care or the level of service
provided to the injured employee.
Bill Review
Utilization Review
We provide an average
savings of 67% for CSAC-EIA.
We combine expert staff and
sophisticated, integrated systems
to review and reduce each bill.
We consistently deliver savings while
still ensuring injured employees
receive the treatment they need in an
expedient and fair fashion. For the
2013 calendar year, we achieved over
$5 million in net savings for CSAC-EIA.
EIA Medical Provider
Network (MPN)
Nurse Case
Management
We offer a highly selective
network of medical providers
chosen for their understanding of
workers’ compensation
issues and the high quality of
medical care they provide. We
have a customized EIA-MPN.
Our proactive case management includes telephonic, field, and on-site.
Our case managers know your providers and understand the nuances of
government agency programs.
Return to Work
We understand that it is better for injured employees’ health and morale—and your
budget—when employees return to work. To improve return to work, we can work with
you to design a customized return-to-work program.
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Our people are everywhere
you are.
We serve CSAC-EIA PWC from five offices in
key locations throughout California.
Roseville
Inland Empire
1101 Creekside Ridge Drive, Suite 100
Roseville, CA 95678
P (866) 221-2402
F (800) 921-7683
313 E. Foothill Boulevard
Upland, CA 91786
P (909) 942-4900
F (866) 548-2637
Ventura County
San Bernardino
1889 North Rice Avenue, Suite 100
Oxnard, CA 93030
P (805) 288-4300
F (805) 981-1378
333 City Boulevard West, Suite 1500
Orange, CA 92868
P (800) 221-7624
F (909) 890-4243
Los Angeles
25115 Avenue Stanford, Suite A-206
Valencia, CA 91355
P (661) 775-4061
F (661) 775-9554
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