Medical Case Management

An essential element of a speedy recovery and return to work is good case management. Health Management Solutions will assign you a medical case manager immediately upon notification of your work-related injury. This medical case manager will work closely with you, your Provider and your employer to make sure you are getting prompt, appropriate care.

All Managed Care Organizations (MCOs) are required by the Bureau of Workers’ Compensation (BWC) to follow certain Treatment Guidelines for determing how the claim should be managed. Health Management Solutions uses Official Disability Guidelines (ODG) for non-chiropractic treatments and Mercy Guidelines for chiropractic treatments. Your medical case manager, in conjunction with your Provider will develop a Treatment Plan for managing your care through out the injury.

In addition, each MCO may require prior approval for certain procedures before a treatment or procedure is eligible for reimbursement. Each MCO maintains its own standards for approving treatment and services for injured workers. The Provider that will be directing your care will be considered the Provider of Record (POR) and is the one recognized by the BWC to request treatment and procedures. All requests for services requiring prior approval must be submitted by the POR to the MCO on the BWC form C-9.

If you, your representative, or your Provider have a medical disagreement over how your treatment is being handled, please discuss with your case manager immediately. If you, your representative, or your Provider feels the issue has not been resolved to your satisfaction, you have the right to file an Alternative Dispute Resolution (ADR) notice.