National Workers Compensation Program

Medical Expenses now account for about 59% of the total cost of workers’ compensation claims nationwide, with some states as high as 65%-70%.  In many respects the worker’s compensation system is based on the quantity of services provided which can lead to over treatment.  Making sure the injured worker is receiving the appropriate level and type of care in the appropriate environment is critical to optimizing efficient and cost effectiveness.

 Accomplishing this can be challenging, but it will be more effective if claim managers can have access to medical experts who reinforce prompt and accurate identification of injuries and programs that provide clear stem-by-step therapeutic guidelines to help determine whether or not a particular treatment plan is both appropriate and cost effective to the employee’s condition.  BMEGateway provides both the medical experts and programs to ensure that quality, not quantity, is the chief determinant of care.

IME & Peer Review Services

Ø      Independent Medical Evaluations

Ø      Peer/Medical Record Reviews

Ø      Radiological/Film Reviews

Managed Care Services

Ø      Utilization Management

Ø      Case Management

Ø       Vocational Counseling

Ø      Labor Market Management/Surveys

Ø      Transitional Skills Analysis

Ø      Pharmaceutical Diagnostic Analysis

Consultative Services

Ø      WC Reserve Allocation

Ø      WC Proact ^HCV

Ø      Litigation Support

Ø      Pharmacology Review

 

Medical Bill Review

Ø      PPO Networks

Ø      Fee Schedules

Ø      Usual & Customary

Ø      DRG & Fee Negotiation