Quality Care. Integrated Services.

MedInsights offers individualized, managed medical care services to insured and self-insured companies.

Services include:

• Field Case Management
• Telephonic Case Management
• Utilization Management
• Pharmacy Benefits Management
• Medical Bill Management
• Medical Legal Review
• Medicare Secondary Payer Compliance & Resolution
• Occupational Health Consulting Services

MedInsights is a division of Gallagher Bassett Services, Inc.

MedInsights' Telephonic Case Management (TCM) services provide medical management services and direction by registered nurses from the onset of the treatment process.

The emphasis is on ensuring "best practice" medical treatment for the work injury and an early, safe return to work.

Our telephonic case management services:

• Provide early assessment within 24 - 48 hours of notification;
• Utilize customer specific criteria, usually based on high risk, high dollar injuries;
• Perform an initial four-point contact with 48 hours of receipt of referral;
• Utilize evidence-based, nationally recognized guidelines and evaluates the care plan for medical necessity of treatment;
• Ensure compliance with state managed care organization regulations;
• Evaluate ADA compliance;
• Establish return-to-work (RTW) targets using Official Disability Guidelines (ODG);
• Promote ongoing coordination between the employee, provider, employer, and claim adjuster;
• Facilitate an ongoing "interactive"" process between all parties;
• Assist in developing modified and transitional return-to-work programs and evaluating progress toward targets;
• Coordinate all ancillary services to deliver optimal, safe return-to-work and recovery.

To request more information, please contact us.

MedInsights' experienced Field Case Management nurses and vocational rehabilitation specialists work with injured parties and medical providers to aid the individual in achieving pre-injury status as quickly and safely as possible. Through use of an interactive process, MedInsights works to achieve mutually agreed upon goals while mitigating Americans with Disabilities Act (ADA) risks.

MedInsights' certified case management personnel apply nationally recognized disability guidelines while carrying out the following types of assignments:

• Individual Task Assignment
• Full Case Assignment
• Catastrophic Assignment

Other types of referrals for field case management services include:

• Comprehensive Return-to-Work Coordination
• Independent Medical Evaluation Coordination
• Comprehensive Vocational Assessments
• Ergonomic Assessments
• Certified Life Care Planning

We realize that every client is unique and has different protocols and parameters for referral to field case management services. Therefore, MedInsights will assist each client in the customization of their referral processes and protocols based on their specific criteria.

To request more information, please contact us.

Certified by the Utilization Review & Accreditation Commission (URAC), MedInsights' utilization management services help clients administer workers' compensation programs more effectively. MedInsights achieved a 100 percent compliance score on its most recent URAC audit.

MedInsights' utilization management nurses and client service professionals:

• Utilize recognized, evidenced-based state and national guidelines in making treatment determinations (e.g. Official Disability Guidelines, Presley Reed, American College of Occupational Environmental Medicine);
• Follow state-specific workers' compensation rules for utilization and access to medical care and specialists;
• Comply with state-specific reporting requirements;
• Coordinate with physicians to provide consultations and peer reviews;
• Negotiate optimal treatment program to expedite timely and appropriate return-to-work opportunities.

To request more information, please contact us.

Using advanced bill review technologies, MedInsights’ Medical Bill Management services help clients identify and reduce inappropriate medical costs submitted by providers across all casualty lines of insurance.

MedInsights’ experienced medical bill management professionals:

• Apply managed care guidelines and utilization parameters;
• Apply negotiated discounts;
• Apply fee schedule or usual and customary rates;
• Identify bundled/unbundled charges;
• Identify duplicate bills;
• Apply PPO reductions;
• Conduct bill reviews on auto liability claims;
• Comply with state-specific reporting and auditing requirements.

MedInsights is e-billing compliant and has standard data imports and exports.

MedInsights provides access to more than twenty of the nation’s largest and most respected PPOs and works with clients to build location-specific PPO networks that meet their specific needs.

To request more information, please contact us.

Through these services, MedInsights’ professionals can help uncover critical “medical facts” and identify cost savings as well identify appropriate long-term treatment needs.

With MedInsights' Med-Legal Review Services, certified Legal Nurse Consultants provide detailed file review and summation of medical-related legal matters. Highlights of MedInsights’ Med-Legal Review Services include:

• Using LNC (Legal Nurse Certificate) and CLNC (Legal Nurse Consulting Certificate) accredited reviewers;
• Helping to reduce legal expenses by use of chronological summary of case activity and medical findings;
• Offering a clear translation of technical information and medical terminology;
• Providing future Medical Cost Projections;
• Achieving average client cost savings of 50 to 70% below settlement demands.

To request more information, please contact us.

To assist clients in reducing their prescription medication costs, MedInsights offers a fully integrated Pharmacy Benefit Management (PBM) program.

Our PBM program has an extensive nationwide network of more than 53,000 pharmacies that provide discount pricing at a significant savings beyond fee schedules or usual and customary charges.

Advantages of the MedInsights Pharmacy Benefit Management program:

• Online eligibility controlled by the claims adjuster;
• Claim-level pharmacy controls;
• No out-of-pocket expenses for injured parties;
• Customizable formulary depending on line of business;
• Point-of-sale electronic drug utilization edits;
• Generic substitution;
• Mail-order services;
• Electronic payment interface.

To request more information, please contact us.

MedInsights is unique in its ability to provide a complete Medicare Secondary Payer compliance Package - from identification through settlement.

MedInsights’ Compliance and Resolution Unit provides all parties with a one-stop resource to ensure compliance with today’s complicated set of laws.

The unit is unique in its combined use of high-level adjusting staff and certified RNs to collaborate efforts in providing services. The comprehensive solution applies cost-saving tools such as the use of our medical bill review system along with reversionary clauses and the use of structured settlements.

To request more information, please contact us.

CRITICAL DATES:

• The RRE Registration period ends September 30, 2009;
• CMS extended the testing period from January 1, 2010 to March 31, 2010;
• Total Payment Obligation to the Claimants (TPOCs) occurring prior to January 1, 2010 are not reportable. This is not true of on-going responsibility for medicals (ORMs), which will need to be reported as of July 1, 2009;
• Reporting will begin April 1, 2010.

Each entity will need to register and designate an agent to provide reporting services. Due to the current structure of the registration process, TPAs are unable to register on behalf of Responsible Reporting Entities. MedInsights is fully prepared to provide reporting services. Registration for non-Group Health entities will open on May 1, 2009 and close on September 30, 2009. Information from CMS is available by going to the CMS Web site.

REGISTRATION PROCESS:

MedInsights is able to assist you through the process and serve as your reporting agent. Prior to beginning the registration process, MedInsights must be notified of your company’s intent to designate MedInsights as your Agent. A MedInsights representative will contact you to discuss the terms of our engagement. Thereafter, you will be required to register as an RRE.

Important Links

Medicare Advocacy Recovery Coalition

Medicare Secondary Payer and You

Center for Medicare & Medicaid Services Reporting Requirements

Occupational and environmental health nursing is the specialty practice that provides for and delivers health and safety programs and services to workers, worker populations, and community groups. The practice focuses on promotion and restoration of health, prevention of illness and injury, and protection from work related and environmental hazards.

Serving as an extension of the client's nursing or safety department, MedInsights works to assess the needs, create programs, coordinate training, and evaluate the delivery of health and safety programs.

MedInsights offers comprehensive occupational health consulting services through its staff of experienced and certified nurses and safety professionals.

Services include:

• Evaluation of existing safety programs, training, and OSHA recordkeeping system(s) and consultation for process improvement of health and safety program;
• Medical data analysis of provider performance to target injury-specific provider referral pathways, assess if alternative on-site health care is beneficial;
• Feasibility analysis of enhanced HR interventions such as post-offer/pre-placement physicals, drug & alcohol program expansion, design of "Interactive Process" of RTW, wellness programs, etc. might improve workforce production;
• Evaluation of emergency management committee effectiveness:
  • Medical Emergency Response Team (first aid, CPR, AED program vaccinations, floor warden) is established, trained, and monitored for renewals. MedInsights has access to a network of national trainers for "MERT" teams Communicable/infectious disease exposure control process consulting:
  • Disease transmission routes are audited for improvement actions (worker/administrative/engineering controls):
    • Airborne
    • Blood-borne
    • Food/Waterborne (employee cafeteria/break rooms, bathrooms, etc.)
    • Vehicle-borne (inanimate contaminated objects)
    • Vector-borne (live carriers such as mosquitoes)
  • Exposure Control process is audited for process improvement of:
    • Worker Treatment
    • Cohort exposure
    • Regulatory Reporting
    • Visitor Control
    • Exposed Worker Re-entry @ work
    • Traveler Management
  • Nuclear, radiologic, biological, chemical and explosive exposures and response capabilities are evaluated for optimal management response.

To request more information, please contact us.