CCP 05-23-1994 - Laserfiche WebLink

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- . LMCIT Member Cities . Page 3 June 3, 1994 . Arrange for physical rehabilitation services . Arrange for needed supplies or equipment . Educate injured workers and their families . Facilitate employee's retum to work. Monitor primary duties and consult with employer about increased workload and/or the lifting of weight restrictions . Coordinate vocational counselling Case managers also serve as advocates for the injured worker by acting as a liaison between 1) the employer and the employee, 2) the employee and hislher medical provider, 3) the employee and the LMCIT claims staff, 5) the medical providers and the claims staff. . Review of Medical Bills A final cost savings factor associated with managed care involves ongoing review of medical bills submitted by medical providers. This ongoing review assures that only those tests and treatments which are pre-authorized and/or medically necessary will be recommended for payment. WHAT COSTS ARE INVOLVED? It varies among the companies supplying managed care services. Some managed care plans charge only for specific services when an injury has occured. Others simply charge on a flat monthly or per-employee basis. For those companies that charge on a per-claim basis, the costs are simply made part of the claim that LMCIT pays. When the managed care fees are paid as part of the claim cost, they are treated like any other charge and are included for purposes of meeting the city's deductible and calculating subsequent years' experience modification. However, LMCIT believes that if managed care works as it is supposed to, it will more than pay for itself through favorable claims experience and reduced premiums. For companies charging on a monthly or per capita basis, the flat monthly or per- . capita charges are billed by the managed care organization and paid directly by the City. . ~-