TCM Workflow

During the initial contact stage, the TCM channels care into an appropriate network is so desired by the customer, coordinates medical care, works with the provider to establish a treatment plan, determines modified duty requirements and targets an early return to work date.

Within 48 hours of the initial referral, the TCM triggers an electronic summary case note to the claims adjuster updating them on vital information and recommendations.

Our TCMs use nationally recognized guidelines for medical necessity review and disability duration management to proactively accelerate and facilitate medical care and to set return to work goals.

As part of our standard TCM services, our TCMs handle every request for medical services as they would a formal request for a medical necessity review. In this way, we assure that cost-effectiveness and medical necessity will prevail for our customers.

We have seen that outcome goals are best achieved when the TCM completes contacts at least every 10 business days. Case note summaries documenting treatment plans and work status are then transmitted to the claims adjustor after each series of contacts. Thus, allowing the customer and TCM to be more proactive in achieving a safe and cost-effective case resolution.

At any point during the case, the customer may decide they desire to refer the file to one of ADM’s Medical Field Case Managers. Referring a telephonic file to the field allows the nurse Medical Case Manager the opportunity of face-to-face interactions with the provider and employee. Should the customer desire this referral, the TCM will assist in transitioning the file to field case management in a timely manner.