Case Management

Under its Oklahoma CWMP contracts, and as appropriate under Oklahoma, Arkansas, Texas, Louisiana, Kansas, Colorado, and New Mexico Managed Care Program contracts, CompCHOICE implements medical oversight and management for every injured worker whose case meets or exceeds levels of medical complexity or "triggers." These "triggers" are approved by the state's regulatory body such as the Oklahoma State Department of Health.

Case Management may take place throughout the course of care, potentially from the first report of injury to the employee attaining maximum medical improvement.

Examples of “triggers” include:

  • Lost time cases >3 Days
  • Specialty referral
  • Surgery is recommended
  • Dispute/appeals
  • Adjuster discretion
  • Exposures (e.g., blood-borne pathogens)
  • Outpatient diagnostic testing (MRI, CT, EMG, etc.)

CompCHOICE maintains an in-house staff of trained Registered Nurse Case Managers to provide active case management. Many of the CompCHOICE Case Managers are certified by one of several independent national organizations. Because prompt, quality medical treatment is often the most effective way to return an employee to work, the CompCHOICE case manager does the following:

  • Provides insight into the appropriate treatment of specific conditions based on national physician-developed protocols and guidelines;
  • Monitors all reported clinical data;
  • Regularly contacts the employee to determine the employee's understanding of his or her care and level of satisfaction with the treatment process, and acts proactively to restore confidence when necessary and appropriate; and
  • Provides regular and timely reports to employers and risk bearers, (i.e., pre-certification request, status report, etc.)

TELEPHONIC CASE MANAGEMENT (TCM)

  • Initial contacts within 24 hours of claim assignment
  • Coordinates all medical care
  • Communicates with adjuster, patient, provider and employer
  • Accessible 24 hours / 7 days per week

FIELD-BASED CASE MANAGEMENT (FBCM)

  • Adjuster will determine if a field-based case manager is needed. CompCHOICE will make contact with Field-based Case Manager and make assignment.
  • Field-based Case Manager will communicate with both the adjuster and the CompCHOICE Case Manager.
  • CompCHOICE will provide medical case management oversight through reports provided by the Field-based Case Manager.