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| Travelers Homepage | Business Claim Services | TravComp |
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 Early Intervention
Preferred Provider Networks
Pharmacy Network
Medical Case Management
Medical Cost Containment
Return-to-Work Programs
In today's changing workers' compensation climate
it's critical to have the best carrier working with
you to fight rising loss cost trends. In every area,
Travelers uses the latest and best tools, integrating
them in the most effective fashion to produce industry-leading
outcomes.
TravComp is a unique workers' compensation
claim management process. It joins together the
work of co-located medical and claim professionals
to promptly handle, thoroughly investigate and fairly
resolve your workers' compensation claims. The result:
a workers' compensation claims management solution
that meets your unique business needs.
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Early Intervention
Early intervention begins when a claim is reported
to our 800 number. The information is sent instantaneously
to our local team of medical and claim professionals
who begin analysis of the case.
Supported by a state-of-the-art software system
that provides expert information on appropriate
medical care procedures and return-to-work time
frames, the medical and claim management team gets
the right professionals involved early in the case.
Case management nurses direct all aspects of the
return-to-work process, from the medical diagnosis
and treatment plan through arranging for appropriate
services.
The TravComp team combines the best practices of
existing and enhanced Travelers claim and medical
disciplines. Along with improving medical care for
injured workers, the program provides a new opportunity
to reduce loss costs and speed the delivery of services
to our customers and their employees.
Preferred Provider Network
Our preferred provider network
is an integral part of TravComp. With presence in
all 50 states and the District of Columbia, Travelers
preferred provider network (PPN) system covers 80%
of the working population with discounts averaging
26% below fee schedules and reasonable and customary
tables. The network adheres to strict credentialing
and contracting protocols designed to return the
injured worker to gainful employment. It was constructed
by medical and claim professionals to treat workers'
compensation-specific illnesses and injuries to
achieve early return-to-work at the lowest cost.
Travelers medical management services division uses
the following mechanisms to encourage injured employees
to use the preferred provider network for all treatment
unless required services aren't available:
- Training and orientation to first-line supervisors, employees,
and claim staff
- Sending a preferred provider network
introductory letter to employees
- Providing Internet access to the Network
Directory
- Providing employers,
claim professionals and providers with local network
directories
- Using our 1-800 PPO InfoLine to access
referrals
- Training providers to ensure referrals
remain in network
Pharmacy Network
Travelers national
pharmacy management network is specifically designed
for workers' compensation so that you pay for the
appropriate amount of medicine at a fair unit price.
A pharmacy card helps the injured employee get necessary
drugs quickly. To reduce overuse, misfills, early
refills, dangerous drug interactions and payment
for unrelated drugs, our system compares all drug
requests against currently prescribed medications.
Medical Case Management
The medical management process
is initiated by the TravComp team in each local
claim office. Case management nurses use state-of-the-art
software medical protocols to effectively control
medical payout and indemnity lost time. They make
case-by-case decisions based on a vast array of
medical information as well as the effect the treatment
will have on the return-to-work plan.
The nurse works together with the claim case manager and all
other involved parties, communicating with both
the employer and the injured employee.
Medical Cost Containment
Travelers reviews all medical bills
on the basis of appropriateness, relatedness, fee
schedule, discounts, and reasonable and customary
rates. Our case managers review and re-price every
bill using Travelers on-line integrated medical
bill re-pricing (IMBR), which has streamlined the
once lengthy process of review, re-pricing and approval
to one day. IMBR is designed to handle local and
state fee schedules, detecting treatments and diagnostic
codes unrelated to workplace injuries. While the
final authority to pay rests with case managers,
IMBR provides immediate information for allaying
the costs of improper prescription or treatment
plans. The system warns us when special actions
such as pre-authorizations are required, detecting
code manipulation practices including:
- Medical visit type edits
- Mutually exclusive procedures
- Incidental procedures
- Single code edits: assistant surgeon
- Pre-post operative edits
- Bi-lateral procedures
- Clinical duplicate procedures
All financial
values, bills charged, re-priced and paid amounts
are stored on the system and continually audited.
Regular reviews of payments are conducted as part
of a quality assurance and financial audit perspective.
We review all medical bills for:
- Fee schedule compliance
- Duplication
- Additional discounts
- Individual service dates
- Diagnosis codes
- Recommended reduction
- Medical necessity
- PPO savings
- Bill upcoding
Return-to-Work Programs
Return-to-work
programs are the cornerstone of TravComp. From the
first notice, we evaluate the injury against objective
return-to-work and medical guidelines. By applying
those guidelines to the work environment, we create
the best possible return-to-work plan including
a diagnosis review, treatment plan, physician management
plan, return-to-work strategy, and determination
of need for catastrophic team assistance. Our medical
team then works with the treating physician to assist
the physician in recognizing return-to-work possibilities.
On-site disability management services are arranged
if needed due to cooperation issues, job assessment
needs, vocational counseling, or other issues.
For
employees whose serious injury precludes the possibility
of returning to the same job, the process of vocational
rehabilitation begins.
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