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Complex Care

Complex Catastrophic Care

Payers spend annually $58.3 billion in benefit payment under Workers' Compensation.* While catastrophic claims only represent 1% of all Workers' Compensation losses, they account for 20% or $11.6 Billion of the overall spend.

Our unique program includes the selection of regional service providers to ensure timely intervention and cost management of high dollar exposure losses at the pre and post excess and reinsurance retention levels. A dedicated local Catastrophic Nurse Case Manager (NCM) is assigned to each case to conduct an assessment and to customize a plan of action to the payer. This consultative,  pro-active approach provides the optimal strategy for all parties involved, ensures timely intervention and cost management of high dollar exposure losses, and applies a best practice approach for excess and reinsurance claim management.

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Our Fully Integrated Approach
  • All services are preauthorized with transparency in price quotes
  • Services are national in scope using regional providers with local knowledge and expertise
  • Service offering includes integration of eight supporting products to execute plan of action using a single platform
  • Catastrophic NCM is supported internally by a care coordination team to executive the plan of action
  • Skill set is aligned and services are rendered sequentially without fragmentation
  • Integration of services using a single platform provides a comprehensive view of costs and savings.

 

*U.S. Social Security Administration, Office of Retirement & Disability Policy, "Annual Statistical Supplement 2011" (Released February 2012)