Services at Total Managed Care include dynamic programs
geared to each individual clients needs.
| Utilization Review |
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TMC provides an objective review of medical information to develop a clear view of an individual's medical and functional status, with identifiable expected outcomes. Services include file review, medical chronology and/or narrative summary; medical research; life care planning; expert case review for merit or deposition assistance, as well as testimony in areas of expertise; special needs recommendation or case management. The purpose of the utilization review program is to safeguard against unnecessary and inappropriate medical care rendered to recipients. Medical services and/or records are reviewed for medical necessity, quality of care, appropriateness of place of service and length of stay (inpatient hospital). |
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| Life Care Planning |
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The Life Care Planning process provides a comprehensive review of an individual's medical history, current health and functional status, as well as identifies future physical, cognitive and social needs, potential complications, and associated costs. |
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| Insurance Consultation |
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TMC provides services that will assist insurance companies in the areas of; medical record review, development of a life care plan or limited future medical needs assessment, and nursing case management for clients with complex medical and physical needs. |
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| Medical Case Management |
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A licensed nurse assists the injured worker or individual with a debilitating illness throughout the health care system. The nurse establishes a therapeutic relationship which facilitates continuity of care, communication, appropriate interventions and resolution of concerns before issues become problem focused. |
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| Wellness and Disease Management Program |
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TMC provides On-site Nursing Care consistent with disease surveillance, educational programs with a focus on healthy habits, counseling, monitoring of chronic diseases, first aid, drug screening, pre-employment physicals, and appropriate physician referrals as indicated. |
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| First Notice of Loss |
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Our FNOL program is designed to, upon receipt of the 5020, immediately channel employees to the appropriate physician as well as review the information at hand for utilization review. When this process is started at the very beginning of a claim we can attempt to contain the costs of that claim by reviewing each treatment request for appropriateness as well as route the employee to a physician who is familiar with Workers' Compensation |
